Where to from here?

This blog is where I get talk about what I would like to see happen in the public health system and how I think we could get everyone using doctors, hospitals and other health services provided by the government.

I acknowledge that the current system is not working, mainly because those that need health care the most are not in a position to get it.  However, in saying that, here in New Zealand we are in a better position than some other countries, like the USA.  In New Zealand we have a public health system that tax payer’s pay for, that everyone has access to.  In New Zealand we have the choice about using a private health system, which may or may not be a better system. I personally, am happy to use the public health system and to not pay for my health care, because I feel that I would be wasting my money.

The New Zealand system is still not ideal and there is a long way to go before everyone gets the health care they need and deserve.  Why are there people who are not able to access the health system our government provides for us? There are many reasons, some are:

•  Access, physical accessibility, transport for example, or lack thereof.
• Cost, being unable to afford to go to the doctors, even if you are enrolled in a PHO (primary health organisation) there is still a charge to see the GP.
•   Ethnicity, people of certain ethnic backgrounds are over represented in the statistics for not accessing public health, I cannot say why in this blog, as it is a very complex issue in itself.
•  Age, statics show that the elderly are, again, over represented in not accessing public health.

(Carroll, Casswell, Huakau, Howden-Chapman & Perry, 2011, Expert Advisory Group, 2012, Woodward & Kawachi, 2000)

I am putting this link to the TED talk by Rebecca Onie (2012), because I feel what she suggests in her talk about how to improve the health care system are ideas that are achievable and would work in a country like New Zealand, due to the Maori holistic theory and perceptions of health care (Ministry of Health, 2012).

One thing I would like to see in the future is partnerships between primary health care services and early childhood centres.  At the moment there are very little in the way of this kind of partnership.  Currently, the public health nurse come to centres to test children’s hearing and vision and some centres have Plunket come in to do the Well Child checks on children who attend the centre.  I feel that this is not enough and teachers and health care providers need to work together more. However, in discussions with peers there are many ethical issues around these possible partnerships which may be holding back this theory.  

The children’s commissioner (2012) has a vision, ensuring that children are at the centre of policies that affect them the most, for example ensuing that all children have “equitable access to health care” (Expert Advisory Group, 2012, p. 29).  The Expert Advisory Group on Solutions to Child Poverty paper (2012) has eight recommendations that I agree with, including making GP visits free 24/7 to all children under the age of 6 (Expert Advisory Group, 2012) and ensuring that all health providers communicate with each other to ensure children do not fall through the gaps in the system. I feel that if the New Zealand government is serious about child health and access to public health they will take seriously the recommendations made by the Advisory Group and will implement policies to ensure that our children’s health is a priority. 

A final thought, I have not had the scope in this blog to write about everything I would like to write about.  I therefore, acknowledge that they may be gaps in my blog.  I am aware of these gaps, but I am unable to cover all I wanted to cover due to word count constrictions.

References:

Carroll, P., Casswell, S., Huakua, J., Howden-Chapman, P., & Perry, P. (2011). The widening

            gap: Perceptions of poverty and income inequalities and implications for health and

social outcomes. Social Policy Journal of New Zealand: Te Puna Whakaaro.

Retrieved from

http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj37/37-perceptions-of-poverty-and-income-inequalities.html.

Children’s Commission (2012). Solutions to child poverty in New Zealand evidence for

action. Retrieved From

http://www.occ.org.nz/__data/assets/pdf_file/0007/10150/Child_Poverty_Report_Web.pdf.

Woodward, A., & Kawachi, I. (2000) Why reduce health inequalities? Journal of

            Epidemiology and Community Health. 54(12) 923-929. Retrieved from

http://www.scopus.com/record/display.url?eid=2-s2.0-0033738620&origin=resultslist&sort=plf-f&src=s&st1=%28why+do+populations+not+access+public+health%29&nlo=&nlr=&nls=&sid=56D66B52518098B704185098AD7D8499.Vdktg6RVtMfaQJ4pNTCQ%3a110&sot=b&sdt=cl&cluster=scoaffilctry%2c%22New+Zealand%22%2ct&sl=60&s=TITLE-ABS-KEY%28%28why+do+populations+not+access+public+health%29%29&relpos=0&relpos=0&searchTerm=TITLE-ABS-KEY%28%28why+do+populations+not+access+public+health%29%29+AND+%28+LIMIT-TO%28AFFILCOUNTRY%2C%5C%26quot%3BNew+Zealand%5C%26quot%3B+%29+%29+#

Current Child Health Policies and Services in New Zealand

This blog will focus on what child health policies governments have put in place to encourage families of all incomes to use the public health system for the benefit of their children.

Current child health policies and services available to all families and children in New Zealand:

Plunket checks, once your baby is six weeks old a Plunket nurse will take over health visits from your midwife or lead maternity carer (LMC) (Ministry of Health, 2013; Pollock, 2012). This means that a Plunket nurse will come to your home and provide you with general health advice and support while doing general health checks on your baby, encompassing the Well Child checks and book (kidshealth.org.nz, 2012; Ministry of Health, 2013; Plunket, n.d.; wellchild.org.nz, 2011). The Well Child books used to be called “Plunket” books, before 1996 (Ministry of Health, 1996; Patterson, n.d.).

Well Child checks were introduced in 1996, as a way to improve and centralise child health (Ministry of Health, 1996). These Well Child checks can be done by a health provider of your choice, many people use the local Plunket nurse, but you are able to use any health provider you feel comfortable with, a GP, Māori or Pacific health provider or Public Health Nurse.  The Well Child checks are for children up to the age of 5 (kidshealth.org.nz, 2012; Ministry of Health, 2013; wellchild.org.nz, 2011).

B4 school checks, introduced in 2008, as a part of the Well Child checks, are assessments that are undertaken by early childhood centres, nurses and parents to help assess how ready a four year old child is for school and if there are any developmental issues that may need to be looked at in greater depth before the child starts school. The B4 school check is not compulsory however, getting a B4 school check done before increases the likelihood of any physical, social, behavioural and health issues being picked up (kidshealth.org.nz, 2012; Ministry of Health, 2013; Neale, 2012; wellchild.org.nz, 2011). If there are any issues you are able to deal with them before they impact on your child’s learning at school. 

All of the above services are free to all New Zealand children.

Free Doctors’ visit for under 6’s is a policy brought in by Labour in 2008, however there was a $32.50 subsidy introduced in 1997 that was widely known as “free under sixes policy” (Hodgson, 2007, para. 13).  Nevertheless, doctors were still able to charge patients for consultations so, visits to the doctor may not have been free for all.   The Labour government wanted all children to be able to access their GP’s readily. Hodgson (2007) stated “we don’t want parents thinking twice about taking their young children to the doctors because of how much it costs” (para. 3).  This policy has not been entirely successful though, in 2010 only 78% of doctors were providing free visits to under 6’s (Fancourt, Turner, Asher, & Dowell, 2010).   Also, even though doctors’ visits are free for under 6’s this applies, mostly, during business hours. Unfortunately, children do not only get sick between 9 and 5 and the cost of after-hours medical care is too expensive for many families (Fancourt, Turner, Asher, & Dowell, 2010; Hill, 2013).   “The goal of universal free care remains unmet, particularly for after-hours care, and maybe contributing to poor child health statistics in New Zealand” (Fancourt, Turner, Asher, & Dowell, 2010, p. 339 ). The National Party’s 2011 policy states that “National will extend free afterhours care for children under six, roll out a comprehensive afterhours telephone health advice service with access to nurses, GPs, and pharmacists”, however, I am yet to find any evidence to confirm that this policy has been implemented.   

My next blog will look at where to from here and possible partnerships between early childhood settings and health providers.

References:

Fancourt, N., Turner, N., Asher, M. I., & Dowell, T. (2010). Primary health care funding for

            children under six years of age in New Zealand: Why is this so hard? Journal of

            Primary Health Care, 2(4), 338-342. Retrieved from

http://www.rnzcgp.org.nz/assets/documents/Publications/JPHC/December-2010/JPHCViewpointDec2010.pdf.

Hill, M. (2013, February 17). Free healthcare? Yeah right. The Press. Retrieved from

 http://www.stuff.co.nz/the-press/news/8315208/Free-healthcare-Yeah-right.

Hodgson, P. (2007). More support for free doc visits for under-6’s. Retrieved from

            http://www.beehive.govt.nz/node/30431.

Kidshealth.org.nz. (2012). Well child/tamariki ora services for under fives. Retrieved from

http://www.kidshealth.org.nz/well-child-tamariki-ora-services-under-fives#block_1397.

Ministry of Health. (1997). Well child/Tamariki ora. National schedule. Wellington, New

            Zealand: Author.

Ministry of Health. (2013). Well Child/Tamariki Ora. Retrieved from

http://www.health.govt.nz/your-health/services-and-support/health-care-services/well-child-tamariki-ora.

Neal, I. (2012, June 24). Ministry ‘hides test’s real purpose’. Retrieved from

http://www.stuff.co.nz/national/education/7159932/Ministry-hides-tests-real-purpose.

New Zealand National Party. (2011). Policy 2011. Health: Primary Care. Retrieved from

            http://www.national.org.nz/PDF_General/Health-Primary_Care_policy.pdf.

Patterson, K. (n.d.). Plunket nurse. Retrieved from

http://www.kiwifamilies.co.nz/articles/plunket-nurse/.

Plunket. (n.d.). Plunket. Retrieved from http://www.plunket.org.nz/.

Pollock, K. (2012). Story: Child and youth health: Page 6 – Primary health initiatives. Te

            Ara: The encyclopaedia of New Zealand. Retrieved from

http://www.teara.govt.nz/en/child-and-youth-health/page-6.

Wellchild.org.nz. (2011). Well child/tamariki ora. Retrieved from

            http://www.wellchild.org.nz/2/.

Inequalities in incomes and health

This blog is going to focus on the second question I asked in my first blog, how does the payment of health affect access to health services for people on low incomes?

In my research about the public health system I have come across some interesting statistics that I want to share with you and these statistics will help answer my question.

OECD and WHO statistics show us that the bigger the income differences in a society the bigger the difference between society’s health (Denton, 2003; OECD, 2011; Peacock, Devlin, McGee, 1999; Wilkinson, 2011). For example, in New Zealand the gap between rich and poor is large and the corresponding statistics on the health of the population is similarly large.

On the flip side of these statistics are countries, such as Sweden and Japan, who have smaller gaps between the rich and poor and as a result the differences in the health of the population are a lot less noticeable (OECD, 2011; Wilkinson, 2011).

When I first saw this graph on a TED talk by Richard Wilkinson (2011) I was stunned, New Zealand is fifth on the graph of countries whose health is worse because of the income inequities.  This was a real surprise for me.  Considering that we have a public health system that is, in theory, available to all, how can we possibly be in such a negative position in the statistics.

Why are there links between the differences in incomes and the differences in the health of the population? What causes health inequalities?

These are not simple questions to answer; it is as complex as the private versus public funding of health.  Have I got the scope to answer this question in this blog? Probably not, but I will try.  

One belief about why there are health inequalities is because “health is generally not high on the political agenda. Policy and planning are heavily influenced by a few elite groups who are least affected by health inequalities” (Prinja & Kumar, 2009, para. 2).

A report written for the Ministry of Social Development tells us that in New Zealand the links between low incomes and poor health are because of

•  lack of money for medicines, 
• lack of good and healthy food, 
• lack of education, 
• the neighbourhood you live in,  
• poor household conditions – cold and damp houses and 
• overcrowding

(Baker et al. 2000; Cheer et al. 2002; Crampton et al. 1997; Ellaway et al. 2001; Howden-Chapman et al. 2007; Lochner et al. 2003; McCulloch 2001; McNicholas et al.2000; Waldegrave et al. 2004; as cited in Carroll, Casswell, Huakau, Howden-Chapman & Perry, 2011).

How does the payment of the health affect lower income families and their children? In New Zealand, I feel that we measure up pretty well, compared to some countries, however, I think we have a long way to go before we measure up to countries like Sweden or Japan.  The public health system is accessible to all New Zealanders, no matter their income, but they must first have the ability to access the services the government has put in place for them.  

My next blog is going to look at current New Zealand child health policies and what governments have done in the past to ensure that children are benefiting from the public health system.  

References:

Carroll, P., Casswell, S., Huakua, J., Howden-Chapman, P., & Perry, P. (2011). The widening

            gap: Perceptions of poverty and income inequalities and implications for health and

            social outcomes. Social Policy Journal of New Zealand: Te Puna Whakaaro. Retrieved from

http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj37/37-perceptions-of-poverty-and-income-inequalities.html.

Deaton, A. (2003). Health, Income and Inequalities. Retrieved from

            http://www.nber.org/reporter/spring03/health.html.

OECD (2011). An overview of growing income inequalities in OECD countries: Main

            Findings. Retrieved from http://www.oecd.org/els/soc/49499779.pdf.

Peacock, D., Devlin, N., & McGee, R. (1999). The horizontal equity of health care

          in New Zealand. Australian and New Zealand Journal of Public

          Health.23.(2).:126-130. Retrieved from 

http://search.proquest.com/docview/215711053/13DB384A0ED30D716D3/3?accountid=39646.

Prinja, S & Kumar, R. (2009). Reducing health inequalities in a generation: A dream or a

            reality? Retrieved from http://www.who.int/bulletin/volumes/87/2/08-062695/en/.

Wilkinson, R. (2011, July). How economic inequalities harm society. [Video

            file].  Retrieved from http://www.ted.com/talks/richard_wilkinson.html.

Should the tax payers pay for a public health system, or should we all take responsibility for our own health care?

I asked two questions in my first blog, should the tax payers pay for a public health system, or should we all take responsibility for our own health care? And, how does the payment of health care affect the ability of lower income families to access health care?

I will be looking at my first question in this blog, while also looking at the history of the Public Health Care System in New Zealand  to see how we got to where we are today.

I will be looking at the second question in my next blog.

So, should health care be paid for by the tax payers or should each individual take responsibility for their own health care costs? 

But first, what is public health, in New Zealand? Te Ara, the encyclopedia of New Zealand defines public health as “health services that are funded by government through taxation” (Pollock,2012, para. 4).  

 Timeline of the Public Health System we currently have in New Zealand

• 1872 the Public Health Act was established to set up health care in each province, 
• 1876 health care was centralised, while local health boards were maintained,
• 1903 the Department of Health was formed,
•  1907 Plunket is formed by Dr Truby King,
• 1926 introduction of immunisations for children,
•  1935 hospitals visits became free,
•  1938 the Labour government introduces a “dualsystem” of health care, private and public health care systems working alongside each other,
• 1941 prescriptions are free,
• 1974 ACC is formed, a fund to provide for accident cover, rehabilitation costs and loss of income cover, the beginnings of a privately funded medical system,
• 1980’s sees the introduction of the neo-liberal free market economy model, effecting the health system, health care providers need to compete in the free market economy,
• 1990’s sees  reforms ensuring that the health department is financially efficient and individualised health services,
• 2000’s public health becomes the priority, eg, smoke free policies, immunisation policies and Public Health Committee is formed. 

(An Encyclopaedia of New Zealand, 1966;  New Zealand Government, n.d.; Plunket, n.d.; Southern Cross Healthcare Group, n.d.; Wikipedia, n.d.).

This timeline is just a small snippet of the complete and complex picture.  The information I have on the timeline are facts and dates I feel are important to show how New Zealand got the current Public Health System, and the formation of the partnership between public and private health care. 

The current New Zealand health care system is primarily paid for by the tax payers.  The government has a Ministry of Health that takes care of providing health care for all New Zealanders. The day to day running of the health system is done by District Health Boards (DHB).  According to Bramhall (2003) NZ was one of the first countries to have a universal health care system (para. 1).  

However, New Zealanders can choose to pay for their own health care through private health insurance.  In May 2012, 30% of New Zealanders had private health insurance (Business Desk, 2012). Private health insurance in New Zealand covers the user for any number of health services including a choice of health care provider, while also having the perception of cutting down waiting time for elective surgeries (Health Fund, 2010; enz.org, n.d).  The insured user pays a premium for their medical insurance cover whereas the public health user  pays no money for most health services and can access all services provided by the DHB (Health Fund, 2010).  Private health insurance users are nevertheless able to access all publicly funded health services. 

Health Fund Association (2010) inform us that having a health system that is funded by both public and private sectors is beneficial in a country as small as New Zealand, as it means people have choices about which health services they use. However, Dare (2012) argues that the public  - private partnership is not evenly balanced and furthermore, the private insurance system is working against the public health system to the private providers benefit.  

Subsequently, I feel after researching the health system to help inform this blog, the question of the health system being paid for by the tax payers or individuals is a lot more complicated than I first thought.  The public and private health sectors work together for the greater good of the overall health system.  The private health care system is for those that can afford it, however if you need emergency medical attention in New Zealand you will get the highest care the provider can deliver, whether  you have private medical insurance or not.  Therefore, the answer to the question is a little bit of both, people who can afford it ought to have private insurance, because they are in a position to take care of themselves subsequently lessening the load on the public system. Those that cannot afford private health insurance should not worry about accessing adequate health care, because the New Zealand government delivers a health system that will provide for you.    

References:

An Encyclopaedia of New Zealand (1966)  Public health.  Te Ara: The encyclopaedia of New

Zealand. Retrieved from http://www.TeAra.govt.nz/en/1966/medical-services.

Bramhall, S. (2003). The New Zealand health care system. Physicians for a National Health

            Program. Retrieved from

            http://www.pnhp.org/news/2003/january/the_new_zealand_heal.php.

New Zealand private health insurance uptake hits a 6 year low. (2012, May 23).   NZ Hearld.

            Retrieved from  

            http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=10807807.

Dare, T. (2012). Private versus public health insurance.  Retrieved from

http://www.auckland.ac.nz/uoa/home/about/perspectives/opinion/template/subsite_news_item.jsp?cid=473849.

Enz.org.nz (2012). Healthcare for migrants to New Zealand – 12 must knows.  Retrieved

            from http://www.enz.org/healthcare-migrants-newzealand.html.

Health Funds Association of New Zealand (2010). Fact file: Health insurance in New

            Zealand.  Retrieved from

            http://www.healthfunds.org.nz/pdf/Fact%20File%20oct2010.pdf.

New Zealand Government. (n.d). Ministry of Health. Retrieved from

            http://www.health.govt.nz/.

Pollock, K (2012). Public health: What is public health?. Te Ara: The encyclopaedia of New

            Zealand. Retrieved from http://www.TeAra.govt.nz/en/public-health.

Plunket (n.d). Our history. Retrieved from

http://www.plunket.org.nz/what-we-do/who-we-are/our-history/.

Southern Cross Healthcare Group (n.d). Southern cross’ early years. Retrieved from

http://www.southerncross.co.nz/about-the-group/southern-cross-group/early-history.aspx.

Wikipedia (n.d). Ministry of Health (New Zealand). Retrieved from

            http://en.wikipedia.org/wiki/Ministry_of_Health_(New_Zealand).

Accessibility to the Public Health System

My social issue blog is about the accessibility of the public health system to our most vulnerable, our children and lower income families. 

Why access to public health for children? I believe if our children are unwell they are unable to fully experience an environment where they can explore, contribute, communicate, feel a sense of belonging and well-being (Ministry of Education, 1996). Teachers must advocate for the children we work with and give them a voice, when they otherwise would not have one. In particular, in a public forum when discussing social issues that are important for our children, such as whether or not children have adequate access to the public health system.

I will be exploring whether or not children and low income families are accessing the services the government has put in place to target them, for example, Primary Health Care.

The Ministry of Health (2013) states “all New Zealand citizens are eligible for publicly funded services”. But is this statement really true and are all New Zealanders accessing the public health system?

New Zealand's public health system seems to be moving towards a user pays health system. Due to a shift of government from the left to the right in New Zealand, there has been a shift in ideology that our public health system should be a system where the consumer pays. Giddens (1997, cited in Adams, 2005) points out that “we live in a social order where economic growth tends to take precedents over all else – but this situation creates a lack of meaning in everyday life” (p. 30). The priority of economics versus the importance of people is beginning to be seen in health policies that have come into effect since National was elected into government in 2008.

I therefore pose two questions, should the public being paying for a health system or should the individual pay as he goes? How does this affect the health of the children of lower income families?

I need to acknowledge that there are other groups that are disadvantaged when gaining access to public health systems, the elderly and Maori and Pacific populations.  However I do not have the word count or scope in this blog to explore these issues.

References:

Adams, P. (2005).Competing visions of society. In P. Adams, R. Openshaw, & J. Hamer, (Eds). 

Education and society in Aotearoa New Zealand (2nd ed.). (pp.4-32). North Shore, New Zealand: Cengage Learning. 

Ministry of Education (1996). Te Whaariki: He Whaariki matauranga mo nga mokopuna o Aotearoa: Early childhood curriculum. Wellington, New Zealand: Learning Media.