NZ's public health care at crossroads

IAIN McGREGOR/The Press

MOVING ON: Andrew Battin, 22, had his last appointment at 198 Youth Health Centre on Thursday

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When Prime Minister John Key told Parliament in February that extra money for health services would "be more limited for several years", he was, in effect, signalling more health cuts after the Budget. No surprises there.

The ageing of the population, the emergence of new and more expensive technologies, and people's rising expectations all add to the rising pressure on health care. Health services are all too easily portrayed as a drain on the country's wealth.

Researchers say those advocating tighter cost containment fail to recognise the economic, as well as social benefits, of health services.

In June 2008, European countries of the World Health Organisation met to discuss a new way of thinking about health systems, in particular a model of relations between health systems, health and wealth, in which each can be mutually supportive.

Conference papers prepared by teams of researchers and economists show that wise, evidence-based health spending can play an important part in improving a country's productivity and wealth.

There is strong evidence from high-income countries that good health contributes to higher employment rates, less sick leave, higher productivity, and a lower probability of early retirement.

Of course, many factors influence people's health, but an effective and efficient health system is a vital one.

A Ministry of Health study published last year showed that a third of our increase in life expectancy over the years was a direct result of better health care, especially for diseases such as stroke, diabetes, heart disease and certain cancers.

Research shows the economic value of increasing life expectancy can be considerable. One European Commission study showed the years of life gained that were attributable to health care in selected countries in the 1990s amounted to a positive economic return on health investment of up to 250 per cent.

The economic costs of not investing in health, on the other hand, are also considerable, as demonstrated in numerous cost- of-illness studies.

One British study estimated the economic burden of coronary heart disease in Britain in 1999 was more than [PndStlg]7 billion (almost 1 per cent of Britain's GDP in that year).

Government decisions to cut services do not eliminate the cost of illness or injury. That cost is simply shifted to the community, where it is carried by individuals, families, employers, other social services and, ultimately, the economy. In fact, the cost is likely to be increased through treatment delays and prolonged illness.

A countervailing argument is that by enabling people to live longer we increase the burden on health services. But evidence is emerging in several countries that older people are healthier than ever, partly because of healthier lifestyles and partly due to improved health care.

The World Health Organisation has found that as health expenditure per capita increases, not only does life expectancy increase, but the number of years of healthy life also increases - and often at a greater rate.

In other words, in some countries people appear to be living longer and the years spent with disease and disability are decreasing, thereby cutting back on relative demands on health services.

The jury is still out on whether that is happening here, because New Zealand has not been gathering robust data long enough to say so with any certainty. Nevertheless, the early signs are promising. Ministry of Health figures show that "healthy life expectancy" at birth began to increase from 2001 at a greater rate than total life expectancy; and the 2006 New Zealand Disability Survey shows (cautiously) that, from 2001 to 2006, self-reported disability fell by 8 per cent for New Zealanders aged 65 and over.

Improvements in New Zealanders' health are due in part to better health care in key areas such as cardiovascular disease, cancer and diabetes management. For example, deaths from cardiovascular disease (heart, blood-vessel disease and stroke, which is the greatest cause of disability in older people) fell by 35 per cent between 1996 and 2006.

Ageing need not pose the huge challenge to health systems that some predict, particularly if the health system and those outside it who influence health are committed to implementing evidence-based policies that promote healthy ageing.

It has been estimated that even small improvements in health (a decline in disability rates of 0.5 per cent a year across all age groups in New Zealand) could offset about a third of projected extra health care costs resulting from population ageing. Faster declines would produce a larger offset.

This reinforces the importance of maintaining a strong investment in health today.

The European countries debating these issues agree the evidence supports a new approach to health policy, where health is viewed as a key investment in wealth, rather than a drain on it.

This is reflected in the European Union's Lisbon Strategy, which includes "healthy life years" as an indicator of progress towards its aims of increasing economic competitiveness and social cohesion.

It appears New Zealand is about to take a different path. Despite recent funding increases, our health funding per capita remains low relative to comparable countries. Sixteen of the 21 district health boards are operating in deficit.

Nevertheless, our services have made an important contribution to improving New Zealanders' health.

Will funding remain sufficient to sustain the positive momentum achieved over recent times? This year's Budget is looming as a crossroads for the public health system.

* Lyndon Keene was formerly the national organiser of the health lobby group Coalition for Public Health. He is now a freelance communications adviser and policy analyst.

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