Health Targets

August 9th, 2007 at 8:47 am by David Farrar

The Government has poured a huge amount of extra money into Vote Health since 1999, yet health outcomes have only marginally improved, or in some cases even got worse.

A CIS report found:

  •  Public health spending doubled in the last ten years, and has increased in real terms by 49% since 2000.
  • Since 2000 the increase in life expectancy has slowed right down. From 2000 to 2004 (the latest available year) the average has only moved from 78.7 to 79.4 years.
  • The rate of decrease in the infant mortality rate has slowed since 1997
  • hospital efficiency would appear to have fallen by 7.7% over the last three years.’
  • The number of elective surgery operations has actually declined since 2000, from 107,366 operations to 105,437 in 2006.
  • Hospital readmission rates—a key indicator of the quality of care—are unchanged from 2000.
  • Hospital mortality rates are unchanged from 2000.

Yesterday the Government finally, after eight years, announced a focus on outcomes rather than inputs or outputs.  This is a good thing as one can then judge the value of any extra spending.  The ten targets are:

  1. To increase immunisation rates of two year olds from 77% to 95%
  2. Increase from 54% to 85% the proportion of adolescents utilising oral health services
  3. An undefined increase for each DHB in elective service discharges
  4. Cancer patients to wait less than eight weeks for treatment to commence after assessment
  5. Reduce the number of avoidable hospital admissions
  6. Increase the percentage of diabates sufferers who have annual checks, and retinal screening
  7. 90% of mental health patients have up-to-date  relapse prevention plans
  8. Increase  proportion of infants breastfed to 74%, from 67%, at six weeks
  9. Increase the proportion of “never smokers” in year ten students by 2% from 54% to 56%
  10. Reduce the budget spent on the Ministry of Health from 1.85% to 1.65% by 2009/10

Now these are a good step forward.  However a few criticisms:

  • Most have no date associated with them
  • Three of them have no hard target for improvement
  •  Some go for an easy outcome but not the best outcome such as targeting the rate of diabetes checking rather than actually aiming to lower the rate of diabates.
    Same also aiming to have more mental health plans in place rather than a more ambitious target of fewer occurrences of mental health problems
  • The Ministry spending target is not very ambitious considering the total health spend is known to be budgeted to increase greatly by 2010 anyway.

It’s just a pity the Government has introduced these outcome targets at such a late stage we may never get to judge them on how well they do in implementing them.

Hopefully though future focus from the Government will be on these outcomes, not just on inputs and outputs as Pete Hodgsosn did in the very release announcing these where he claims:

  • 150,000 New Zealand women get free mammograms each year
  • an additional $2.2 billion has gone into primary healthcare
  • an extra 4000 nurses and 1200 doctors have been employed

All true and maybe all good, but the point of health spending isn’t for money spent, more doctors and more nurses, or even more cancer checks.  It is to have a lower mortality rate from cancer, a healthier population, less illness etc etc.

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13 Responses to “Health Targets”

  1. DavidW () says:

    CIS report says …..”The number of elective surgery operations has actually declined since 2000, from 107,366 operations to 105,437 in 2006. ”

    Hodgson claimed in the House this week that a new record for elective surgeries has been set – from recollection he said ” more than at any time in our history”

    They can’t both be right.

    Did Hodgson mislead the House?
    Is the CIS being innaccurate?
    Can vets rewrite the principle of mathematics?
    Are the definitions the same?

    I’m confused

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  2. Porcupine () says:

    Personal targets:

    Touch my toes at least once a day 50%
    Cut down on coffee -50%
    Believe anything a barn dancing cow doctor has to say, Priceless.

    These targets are as much use as the 3468 Health Department bureaucrats who wrote them.

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  3. Porcupine () says:

    I think Hodgson has spent too long keeping sacred cows alive!

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  4. thehawk () says:

    Without delving into the figures but taking David’s quoted figures – to achieve a 0.7 year increase in average life expectancy over just a 4 year period is massive!! Given that if you achieved a 4 year increase during that period it would probably halve the number of folks dropping dead during that time, then 0.7 should be seen for an amazing improvement.
    It is probably a screwed up figure though. . for example if Asians and Europeans live longer than Maori or Polynesians all one has to do is increase immigration from the UK or China and Hey Presto! Average life expectancy increases. Gosh! That isn’t how it happens is it?

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  5. roger nome () says:

    lol … again with the CIS reports David :-)

    The Centre for Independent Studies (CIS) is an economically liberal (or neoliberal, depending on your point of view) and socially conservative think tank based in Sydney. It is headed by Greg Lindsay.

    According to Peter Coleman – former editor of Quadrant Magazine, “A turning point came in 1979 when Hugh Morgan, of Western Mining, invited Lindsay to Melbourne for talks. Together they worked the phones. Morgan persuaded nine (actually six) companies to chip in $5000 a year for five years.” [1] According to Paul Kelly in “The End of Certainty”, those six companies were WMC, CRA, BHP, Shell, Santos and the Adelaide Advertiser.

    Also, the CIS, while asserting that research is not “directed” by its supporters, clearly makes an effort not the advocate policies which would disadvantage its many corporate donors. For instance, while the Centre has been a strong advocate of liberal economics (ie: opposing government intervention in the economy), it has always avoided the issue of considerable government subsidies for Australian mining and oil companies, with whose money the CIS was founded and which continue to be major CIS funders (see below).

    The CIS also keeps almost all of its corporate funders secret. While it receives at least $800,000 from corporations, its policy is only to identify sponsors where they agree. [7] Companies which have been publicly disclosed and confirmed by the CIS as its funders include: BHP Billiton, Shell, ICI – now a subsidiary of Orica
    Vincent Fairfax Family Foundation,

    Former Funders
    McDonald’s Australia
    Philip Morris
    Pratt Foundation
    WMC (once known as Western Mining Corporation, WMC was taken over by BHP Billiton).

    http://www.sourcewatch.org/index.php?title=Centre_for_Independent_Studies

    [I wouldn’t classify it as socially conservative. It tends to be pretty classical liberal. They also get funded by people like me who pay $250 a year to be a member. Many Australian Labor MPs contribute to the CIS and beleive it provides valuable policy advice, even if they don’t agree with it all.

    As a policy wonk I want as many thinktanks as possible contributing ideas and putting policies forward. That’s how we make progress]

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  6. roger nome () says:

    Wonder if New Zealand’s CIS centre gets funding from our private health industry/companies? Now there would be some interesting research.

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  7. Porcupine () says:

    Yes that would be interesting roger. It is useful to have something balance up the university’s panchant for always toeing the welfare/big government line.

    There is a fundamental difference though – donating to the CIS is optional but “donating” to the universites is compulsory.

    Re the open government ideas how a bout we add
    – complete trtanparency as to where your money goes and how it is spent
    – payer has the option of earmarking what the money is spent on

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  8. Calculus () says:

    More of the same !!

    As always incredible increases in bureaucracy marked by corresponding increase in cronyism appointments.

    The classic markings of a failed socialism delusion.

    • Attempt to make the people belief that they can’t be given tax cuts, because we can’t afford them.
    • Promise to give them x-amount of common operations but make them wait longer for everything else.
    • Regularly announce sweeping reviews of DHB’s etc but make no costly changes.
    • Continue to throw more staff in the offices so that the frontline medical staff have more paper to battle instead of bugs.
    • Keep the public happy by expressing huge mock indignation about medical mishaps or mistakes.
    • Routinely recreate national health providers and then divide them back into district bodies.
    • Subtly but consistently make the taxpayer pay more for general and specialist health care and then announce new subsidies to lower income groups.
    • Carefully change around the funding for medicines so again the taxpayer gets to pay more for Pharmaceuticals himself but again promptly announce relief for lower income groups.
    • Maximise opportunities to promote care of children while quietly cutting back on age care because they don’t make so much bad press as younger families can.
    • Always oppose contracting out health care to more efficient providers because that reduces the Public Service automatic voting support.
    • Where every it is possible to get away with it make it user pays- but always allowing special benefits for under earners and beneficiarys.
    • Make sure wealthy people pay for everything possible they must not get any value for their tax dollars paid they don’t deserve it – wealth redistribution is our modus operandi !

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  9. baxter () says:

    ‘Reduce the number of avoidable hospital admissions’

    Is this bureaucratese for removing patients from the waiting list and referring them back to their GP until they die.

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  10. Gooner () says:

    Roger – thanks for the copy and paste about CIS.

    The figures and facts are the issue. Care to debate those?

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  11. JamesE () says:

    My view on the public health system is this quote from the linked article.

    “….But a government should feel guilty about encouraging the belief that more medical spending will compensate for avoiding individual lifestyle choices with real health benefits – exercise and healthy eating.”

    http://www.stuff.co.nz/4129646a1865.html

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  12. Porcupine () says:

    Yep at least we’ve now found a whipping boy eh?

    Perhaps Goodwins 2nd law should be “until someone finds a scapegoat, preferably a disgusting ugly one that doesnt look anything like glossy pictures in MSM adverts”

    Hey JamesE I’m not getting at you I know your not actually like that but i couldn’t resist highlighting the latest media sacred cow that we are not allowed to question.

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  13. JamesE () says:

    Hey Porc.

    No worries mate. It would be optimistic in the extreme to describe my physiche as athletic, so I’m hardly gonna be criticising people who are deemed “overweight”. I guess not everyones aware that BMI is NOT an indicator of health, but rather a tool used for statistical purposes, particularly by the insurance industry.

    “Doctor Stephen Stannard is a Senior Lecturer at Massey and has done a number of studies into body composition. He said BMI is a statistical tool and that’s about all. Doctor Stannard said BMI wasn’t a means of predicting health outcomes in an individual.”
    http://tvnz.co.nz/view/page/410965/1193204
    I too deplore the pollies’ and the MSM’s hysterical uproar over the “obesity epidemic” and just other pathetic example of their blatant disregard for the feelings of others in the cynical pursuit of political pointscoring and sales/advertising in their “rags”.

    I do believe their is a problem though. I do realise that BMI is NOT a scientific indicator of a persons health, but is merely a tool used for statistical purposes.

    I also think its criminally stupid to assume that people are able to make good health choices despite the heads of our households working the longest hours in the Western World, some particularly the least advantaged, have to work two jobs to make ends meet, a society that actively promotes a sedatary and unhealthy lifestyle through the promotion of passive entertainment options like video games, television, and reading, that doesn’t adequately resource more active leisure activities, and that promotes the least healthy food options to people who are least able to make healthier food purchasing decisions.

    My belief is based on my awareness that a peverse result is that people have no incentive to look after their own health as they’ll be looked after by the government to the detriment of others who make better health decisions who have to pay more tax to fund the damage that others have done to their health, but that doesn’t mean that I support the profit-motivated private health companies providing our healthcare, because the privately funded health system in the United States costs them more than twice what we pay percapita for WORSE health outcomes. This article had alot to do with me coming to the conclusion that our health system is in dire need of drastic reform.

    “However, they are fighting against parents who bring greasy lunchtime offerings for youngsters who are not allowed to leave the school grounds.”
    http://www.stuff.co.nz/thepress/4100934a19718.html

    If the parents knew that they had to be accountable for what they feed their kids, do you think they’d be that stupid?

    I think health funding should be totally delinked from government funding and that people who make wise health choices should be rewarded, not punished. I have copied my proposal for health reform below.

    Our health service (including ACC) should be set up as independant non-corporate trusts that would be paid for by individual’s compulsary signup to an insurance scheme, administrated by a central body (government?) to reduce unnecessary duplicated administraters and managers. The staff would be incentivised through performance bonuses for producing positive results in healthcare outcomes rather than for making the most profits or having the least costs.

    The trusts should be regularly audited by an independant body and the results made public so that people can make their decisions based upon who to join on the ability of the organization rather than the costs of care.

    This would motivate the organization and its staff to improve their performance as they would be able to share more of the “profits” that would result from the improved health outcomes rather than in the traditional private health system where whoever owns the company reaps the majority of the profits. The number of providers should be limited to prevent the bloated private beauracracy that exists in the United States, which caused the health costs to accelerate rather than decrease.

    Some time of course would be required to phase in the reform, which would allow time for people to be made aware that their poor decisions would have an impact on the provision of healthcare and would all them to adjust their lifestyles. Healthcare provider’s should not of course be able to target people with congenital conditions in order to skew their “health outcomes”.

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