How do we strengthen primary care and invest in innovative services to future proof New Zealand’s health sector?
New Zealand is not alone in trying to encourage more innovation in the delivery of primary care. Industrialised countries throughout the world are increasingly interested in how to support their primary care systems to address the prevalence of chronic disease and improve health outcomes, particularly among underserved groups. As more resources are devoted to specialised care, countries are grappling with how to structure their delivery systems to support primary care and prevention.
The New Zealand public health system has undergone a series of reforms over the past 30 years, many bringing structural change alongside a shift in policy direction. The 1990s were characterised by the purchaser-provider split and the formation of Independent Practitioner Associations (IPAs) and other networks. The early 2000s focused on developments resulting from the 2001 Primary Health Care Strategy, including the creation of PHOs and the move to capitation. 2008 on, included the ‘Better, Sooner, More Convenient’ policy approach and business cases, and the move to mandated DHB/PHO alliances. During these three periods of primary care development (i.e. the 1990s, the early 2000s and 2008 onwards), policy makers were using different combinations of policy tools to drive change. At a greatly simplified level, these tools were more likely to involve larger scale interventions during the 1990s, fiscal incentives to generate new thinking in the early 2000s, and softer influencing tools after 2008.
The challenge for New Zealand and other countries is that the evidence around different models is mixed and their successes are varied. Success of new delivery models is highly dependent on the specific context under which they are operating.
In Canterbury, previous reports have shown how building a strong case for change and a long-term partnership between local organisations (the IPA, PHO and DHB), with an emphasis on ‘one system, one budget’, has created a sound platform for innovation and has been associated with reduced waiting times, reduced hospital bed ‘gridlock’, and reduced emergency department use.
There are a number of barriers to primary care innovation that have been evidenced as well. For example, those practices that rely on patient co-payments have continuing incentives to maintain patient volumes in traditional face-to-face interactions. Any new service innovation (such as telephone triage or on-line consultations) needs careful change management support to ensure practices maintain their expected level of income.
Currently, work is being undertaken to review primary care settings and arrangements. While New Zealand’s health sector performs relatively well, survey data show that nearly 30% of the New Zealand population reports they are not able to access timely primary care. The promise of the health sector reforms has not been fully realised. The time is now!