Time For Change: Right Time To Look At A Fundamental Change In The Funding Model For Health In New Zealand

Primary and Community Health Aotearoa (formally the Federation of Primary Health Aotearoa New Zealand) are calling for an urgent change to the way our health system is funded. We were surprised and disappointed at the offer from Government of a 4% capitation uplift to general practice, while also noting that other community service providers have recently been offered as low as a 2.51% uplift for annual cost pressures – which is insufficient to cover current cost pressures. It could hardly have been a surprise that the primary and community healthcare sector have unanimously rejected these offers. These are inadequate funding offers to a primary and community healthcare sector that is facing sustainability pressures because of population growth and increased demands from an ageing population. These offers have not taken into account the difficulties in recruiting and retaining a workforce able to attract better salary and conditions in other parts of the health sector.

Actions to address inequities in access, quality of care and health outcomes for all populations in Aotearoa/New Zealand, has long been a focus of the health system. Given that these inequities still exist and are worsening in this challenging economic downturn it is disappointing that Government supports the increase in copayments for accessing general practice to offset the gap in funding presented by the 4% capitation uplift. Many practices will not be able to increase copayment levels as their patients will not be able to cover these increases. As a consequence it is likely that these practices will struggle to maintain current levels of services, and there will be an increase in emergency department presentations. As we know all emergency departments are struggling to provide care for the number of patients presenting now. Patients are waiting 6 to 10 hours to be seen in many centres.

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Primary and Community Health Aotearoa acknowledges that there are pressures right across all sectors in the health system but is of the view, there is a significant under investment in primary and community health. There has been an increasing proportionate investment in hospital and specialist services over time, with estimates showing that hospitals now receive 62% of total budgeted funding across primary and community, and hospital and specialist services. Dr Reti, the Minister of Health, who is a general practitioner will know of the existing evidence that an appropriately resourced and well functioning primary and community health care provider sector reduces demand in hospital and specialist services – the most expensive part of the system.

Primary and Community Health Aotearoa has the ability and commitment to assist Te Whatu Ora re-design primary care funding and its current commissioning model. The current primary funding model disadvantages those people who use practices working in areas with high concentrations of people with multiple complex health needs. These practices have long been known to be operating unsustainably.

Commissioning in the community sector is burdensome, highly dependent on officials wanting to purchase services – not a commissioning model but a buying model. This model prevents providers from investing in developing innovative services informed by their knowledge of what is needed in the sector. Primary and Community Health Aotearoa has already developed a robust commissioning model and are keen to socialise it with Te Whatu Ora. Our community provider members are struggling in this environment and so are the people they provide services to.

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