DHBs in for big shakeup amid healthcare review

A wide-sweeping review of New Zealand’s public health system will consider new funding arrangements and whether the District Health Board system ‘‘helps or hinders’’ the provision of healthcare.

Health Minister David Clark announced the review and the appointment of long-time Labour operative and former Helen Clark confidante, Helen Simpson, to spearhead it.

The terms of reference outline a mandate to look at whether ‘‘the current geographic distribution of services help or hinder the system as a whole’’, as well as ‘‘how financial resources applied to health funding could be altered to provide greater flexibility in allocation’’ transparency and ‘‘reduce inequities through targeting those in need’’.

The distribution of health services is carried out through the DHB system; 20 geographical regions, with boards that are responsible for delivering health care services at both the secondary and tertiary levels in that area.

Their funding is providing by the Ministry of Health which receives a total allocation from the Government and then divides between DHBs according to a complex funding formula based on population growth, age and ethnicity as well some other demographics.

It’s a devolved system that affords DHBs the independent decision-making power over what to spend their money on according to the needs of their communities.

But Clark says it’s time that was reviewed.

‘‘We need to face up to the fact that our health system does not deliver equally well for all. We know our Ma¯ori and Pacific peoples have worse health outcomes and shorter lives. That is something we simply cannot accept,’’ he said.

The review was expected to deliver an overhaul of the health system that would carry it for ‘‘decades to come’’.

‘‘The review will include a strong focus on primary and community based care. We want to make sure people get the health care they need to stay well. Early intervention and prevention work can also help take pressure off our hospitals and specialist services.’’

‘‘Our health system doesn’t deliver equally well for all. We know our Ma¯ori and Pacific peoples have worse health outcomes and shorter lives. That is something we simply cannot accept.’’ Health Minister David Clark

The review’s terms of reference talk of the ‘‘current devolved health system’’ which was a ‘‘complex mix of governance, ownership, business and accountability models and arrangements’’.

‘‘This complexity can get in the way of ensuring public money is spent to invest in, and provide healthcare to the public in a coherent and smart way.

‘‘The Government’s starting position is that the guiding principle for the New Zealand health system – namely, a public health service that delivers good health outcomes for all New Zealanders – is sound.

‘‘We need the review to be very explicit and provide evidence around where the system is not achieving this core goal. This includes meeting with a diverse range of New Zealanders, identifying who is missing out, why and how we need to improve the health system.’’

In 2015, the previous Government ruled out a series of proposed reviews to DHB funding structures and governance.

Former Director-General Chai Chuah carried out a number of internal reviews, which advocated reducing the number of democratically-elected board members and major changes to the funding system.

That included a proposal for a pools of contested funds, which at least partially hinged on a DHB’s plan to hit certain targets or milestones, and penalties if those targets were missed.

The reviews were not Government policy at the time and both former minister Jonathan Coleman and former Labour health spokeswoman Annette King appeared to dismiss their contents.

Simpson, who was the chief of staff to former Prime Minister Clark from 1999-2008, also has a background in health economics.

An interim report is due from the panel by the end of July, 2019, and a final report by January, 2020.