Document for PDF - Ministry of Health

Improving 

Our Health 

Te Whai Ora : Te Wero mo Aotearoa 

The Challenge for New Zealand

Mission Statement 

To allocate resources that secure the best health and independence 

for all New Zealanders. 

HFA Improving Our Health 1

Mihi (greetings) 

Tiheewa! Mauri! Ora, 

Ki nga tini aitua, nga mate huhua, mai I muri whenua, 

Tika tonu atu, ki te rerenga wairua haere, haere, haere 

Ki a tatou te hunga ora tena koutou 

Kia kaha tonu tatou ki te hapai I nga ahuatanga 

Katoa mo te iwi Maori ara nga iwi katoa o 

Aotearoa na reira kia u mai. 

Kia ora huihui mai ano tatou 

2

Foreword 

The Health Funding Authority has had the role since October 1998 of contracting, 

funding and monitoring public health services that the Government provides for the benefit 

of New Zealanders. 

From July this year the Government is introducing structural changes to the health sector 

that will widen the functions of the Ministry of Health to incorporate HFA functions, and 

establish District Health Boards. Though the planned change more appropriately reflects 

the Government’s vision for the health system, I feel that it is important to build on the 

substantial good work expert staff members within the HFA have been doing, and to 

acknowledge what they have achieved. I thank them for their efforts. 

I am pleased that this document, Improving Our Health: The Challenge For New Zealand, 

has been produced as an information resource for the health sector. It outlines some of the 

issues and the exciting and innovative initiatives in Personal Health that the HFA has 

undertaken, and provides valuable and enlightening funding information. The new District 

Health Boards, as they come on stream, will be able to build on much of the work done by 

the HFA. 

Meanwhile, I do not want to lose any of the momentum for improvement in the health 

arena and I look forward positively to continuing those worthwhile partnerships that 

exist already. 

Hon Annette King 

Minister of Health 


Personal Health 

Almost every New Zealander has used health services purchased by the Personal Health 

operating group of the Health Funding Authority. General practitioners, midwives, 

laboratories, pharmacists, dentists, hospitals, hospices, nurse practitioners, and 

ambulance services are just some of the health care providers funded by Personal Health 

on behalf of the Crown. 

Personal Health is the largest of the HFA’s operating groups, responsible for about twothirds 

($3.8 billion) of the HFA budget allocated to fund public health services. It comprises: 

the Service Strategy Team, the Change Management Team, and Locality Teams, who manage 

and contract health services in 11 Locality areas around the country. 

Personal Health Locality Teams have had a local focus within national frameworks, based 

in five HFA offices: Auckland, Hamilton, Wellington, Christchurch, and Dunedin. 

They arrange most of the approximately 1100 health services contracts with the various 

health service providers. For example, the HFA has contracts and funding arrangements 

with doctors, independent Maori health providers, hospitals, laboratories, pharmacies 

and midwives. 

The Personal Health Service Strategy Team has developed national frameworks for 

purchasing public health services to guide localities and ensure the public can get the 

same level of health service around the country. The Locality Team has assessed community 

needs and the effectiveness of local services as the basis of a Locality health plan. 

The Personal Health Change Management Team has ensured that changes to health services 

worked for the health sector, that the community could see the benefits, and that national 

change projects were implemented in a timely manner. 

This document, Improving Our Health: The Challenge for New Zealand, outlines the challenge 

that the Personal Health operating group of the HFA accepted and what has been done 

during the 1999 year to improve the health of New Zealanders, within the resources 

available, to fulfil the Crown’s health objectives. The HFA is required to provide information 

to stakeholders. Here we offer a snapshot of: health issues in the four main localities, 

issues of major focus, progress made working with the many health providers, and important 

clinical issues. 

The work of the Personal Health group, as a high performance organisation, has made a 

huge and positive difference to publicly-funded health services, by promoting innovation, 

equity, accountability, quality and integrity, and by valuing people. 

David Moore 

General Manager, Personal Health 

4

Maori Health 

As the Government moves to implement its change programme within the health sector, 

it is timely to reflect upon what the Health Funding Authority (HFA) has achieved in 

terms of Maori health. This document forms part of that review. 

Clearly, the Personal Health group has been a major contributor to a rapidly growing 

awareness within the sector that Maori health needs are complex and substantial. 

Some of the complexities include the need to carefully select providers who are well 

equipped to deliver effective services to Maori. The quality of working relationships between 

the Personal Health and Maori Health groups of the HFA has contributed significantly to 

sound selections of a wide variety of capable providers. 

Moreover, the sharing of HFA resources between the various Operating Groups of the 

HFA, both of human and technological natures has provided a focused perspective on 

Maori health issues, which has helped to identify priorities. This focus on priorities has in 

turn called for innovative funding agreements to be developed with providers in ways 

which match Government’s policies. 

Some of those innovations are expanded upon later in this document. 

Also touched upon is the growing capacity of the HFA to identify gaps in services to 

Maori, particularly within what are often referred to as “mainstream services”. This growing 

capacity will become an essential feature of organisational competence within the public 

sector as Government policies on eliminating disparities and Maori developments become 

translated into action. 

Consequently, the experiences learnt in the HFA’s Personal Health Group, in regard to 

Maori health, are experiences which can contribute to the health sector as a whole, especially 

for the benefit of Maori. 

Rob Cooper 

General Manager, Maori Health 


In New Zealand every day... 

150 babies are born 

40,000 laboratory tests are analysed 

6800 outpatients visit hospitals for care 

460 people have surgical operations 

68,000 prescriptions for medicines are filled 

6

Contents 

Foreword 3 

Personal Health 4 

Maori Health 5 

The Challenge: 

Improving Health for all New Zealanders 8 

Localities: The Face of Personal Health 11 

Auckland Locality 11 

Hamilton Locality 12 

Wellington Locality 14 

South Island Locality Offices 15 

Our Focus 17 

Maori Health: Action Oriented Strategy 17 

Pacific Island Health: 

Growing and Young Population 18 

Child Health: High Levels of Activity 19 

Rural Health: Continual Focus 19 

Service Gaps: Being Addressed 20 

Working with Providers 21 

Hospitals: Purchasing Strategy 

and Issues 21 

Primary Care: Well Advanced 21 

Telephone Advice: 

A New Concept in New Zealand 22 

Pharmacy: Needs to Adapt 22 

Laboratory Contracts: Poised to 

Move Forward 23 

Maternity: Direction Correct but 

Improvements Required 23 

Clinical Issues and What We are Doing 27 

Waiting Times: Patient Focused Care 27 

Complex Medicine: Managing the Issue 29 

Diabetes: Moving Forward 29 

Asthma: a High Priority 30 

Heart Disease: Preparing the Way 30 

Oral Health: Focus on Youth 31 

Immunisations: Revamp in Action 32 

Hepatitis B: Screening Introduced 32 

Sexual and Reproductive Services: 

Under the Microscope 33 

Oncology: Reviewing Drugs 

and Radiation 33 

Palliative Care: Studied for the 

First Time 34 

Cervical Screening Investigation: 

Gisborne 34 

Paediatric Speciality Services: 

Review Underway 35 

Personal Health Financial Information 36 

Relationships With Communities 44 

Personal Health Senior 

Management Team 44 

Personal Health - 

External Advisory Groups and Committees 50 

Technical Working Groups within 

Health and Hospital Services 51 

Health - What’s Driving the Future 56 

Accident Insurance Reform: 

Significant Risks 24 

Quality: Transforming the Sector 24 


The Challenge: 

Improving Health for all New Zealanders 

The challenge to the HFA’s Personal Health group has been to improve health status within a given budget. 

The challenge is complicated - we cannot affect all of the determinants of health, we cannot do everything at 

once - but it has been important to us. 

Accepting this challenge required a mind shift from most of the activities of a health purchaser. For instance, 

in the days of the RHAs it was largely acceptable to contract for services, and manage to budget, without 

feeling responsible for outcomes. Implicit in accepting this challenge is that, in a very New Zealand way, 

there needed to be a fair chance for all and a need to focus resources where they would make the most 

difference. 

The biggest challenge is improving Maori health. Maori health is significantly under par - the table below 

dramatically shows the additional burden of disease carried by Maori, compared to the non-Maori population. 

Age Standardised DALY Rates for Cause Groups by Ethnicity 

Non Maori 

Maori 

Musculoskeletal 

Infection 

Infant peri-natal conditions 

Other chronic 

Endocrine 

Neurosensory 

Respiratory 

Injury 

Mental 

Cancer 

Cardio Vascular Disease 

0.0 10.0 20.0 30.0 40.0 50.0 60.0 

rate per 1,000 

Note: The Disability Adjusted Life Year (DALY) is a standardised Quality Adjusted Life Year (Qaly) type measure equal to the 

sum of Years Lost to Premature Mortality (YLL) and Years Lost to Disability (YLD). 

8

The increased mortality associated with the difference in health outcomes is demonstrated in the graph 

below. This graph is for the Wellington region but is broadly indicative of the pattern nation-wide. 

Proportion of Deaths Occurring at Different Ages in Wellington 

Residents 1990-94, by Gender and Ethnicity 

Maori Male 

Maori Female 

Non Maori Male 

Non Maori Female 

100% 

Proportion of Deaths 1990-94 

90% 

80% 

70% 

60% 

50% 

40% 

30% 

20% 

10% 

0%

Adoption of health outcome targets 

The fourth Labour Government introduced health outcome targets according to disease or high health 

risk behaviour. 

Personal Health has been implementing these measures. We accepted the targets and devolved the measures 

to localities, off the back of the analytical work highlighted in the Wellington locality section, together with 

appropriate, revised budget measures. Work will continue measuring management performance against 

the targets. 

One set of targets is shown below, with comments on the trends. 

Target Indicator Target Level (year) Current Level Base Line Level 

(year) 

Future Trend 

Required 

Historical Trend 

Comment/Trend 

Hearing Loss 

Hearing Loss - all 

children 

Test failure rate at 

school entry 

5 percent (2000) 8.4 percent 

1996/97 

10.5 percent (1991) -12 percent pa -4 percent pa Tracking toward 

health but slow 

Hearing Loss - 

Maori children 


school entry 


1996/97 

14.8 percent (1991) -21 percent pa -3 percent pa Tracking toward 

health but slow 

Hearing Loss - 

Pacific children 


school entry 


1996/97 

14.0 percent (1991) -25 percent pa +3 percent pa Tracking away 

from health 

One of the major findings from attempting to apply this framework as an operational environment is the 

lack of timely, accurate information. 

Extension of existing frameworks 

Our current work has been based on existing frameworks. The following is an example of how the table can 

be extended in the near future. 

Possible Health Indicators and Targets 

Indicators 

Targets 

Maori Health 

Medical/Surgical 

Child Health 

Separate reporting by ethnicity for all indicators listed below 

Reduction in: 

Maori smoking rates 

Maori asthma admissions 

Rate of maori low birth rate babies (

Localities : The Face of Personal Health 

The community responsive arm of Personal Health has been organised in five locality offices (with two in 

the South Island). These offices are small (15 people in Auckland and in the South Island, 12 for 

Wellington and Hamilton). 

They manage contracts for local needs by running the budget, managing relationships with communities 

and providers, and implementing change through nationally consistent contracting frameworks. Much of 

the work has been done in moving to national consistency but less has been done in local innovation. 

There are notable positive exceptions, and all localities have dealt with issues in their own particular context. 

Auckland Locality 

Area served: Auckland, Northland 

Total population: 1.2 million 

Population Characteristics 

The Auckland localities include the poor rural 

Northland area and the large urban area of Auckland. 

• About a quarter (129,195) of all Maori live in the 

Auckland locality. 

• 80 percent of New Zealand’s Pacific Islands 

population lives in the Auckland locality. 

• The Auckland population is increasing at a faster 

rate than other parts of the country. 

• South Auckland has a high deprivation rating and 

poor health status 

• 72 percent of Maori in Counties Manukau live in 

the highest deprivation areas (deciles 8 -10). 

• 90 percent of Pacific Islands people in Counties 

Manukau live in the highest deprivation areas 

(deciles 8 -10). 

Specific Locality Issues 

Rapidly growing population and critical health status 

are the issues that most concern the Auckland locality. 

The critical situation in South Auckland has caught 

the attention of the public. Currently acute medical 

admissions are growing at 9 percent (the national 

average is 3 percent). Our team in Auckland has 

been working hard on solutions for both the short 

and the long-term. We expect to implement these 

initiatives in time for this year’s winter peak. 

The longer-term solution will take three to five years. 

Less visible, but equally critical, are issues in 

Northland. One example is its burgeoning need 

for dialysis services. There are many others. Our main 

focus has been to maintain and enhance the energy 

previously put into Northland by working with 

community groups, supporting Northland Health 

and seeking innovative ways of getting to the needy 

(e.g. mobile clinics). 

Poor health is not just a Maori issue, but also a Pacific 

Islands one. Auckland has most of the country’s 

Pacific Islands peoples so most of our Pacific Islands 

team is based in Auckland. 

An example of the size of the issue is immunisation. 

Among two-year-olds with complete immunisation: 

tamariki Maori have a 45 percent immunisation rate, 

Pacific Islands children rate 53 percent, and 72 of 

other children are immunised (last available figures 

are 1996). 

There is also considerable reshaping of hospital 

services in Auckland. Auckland Healthcare is 

constructing a new 710 acute bed tertiary facility 

and decreasing its secondary care. We are seeking 

to expand significantly (over the next 5 - 10 years) 

the range of secondary services delivered close to 

home on the North Shore and South Auckland, 

but particularly West Auckland. There is a great 

deal of tension between the three hospitals over 

the timing and size of the service adjustments. 

The Auckland office has been leading a significant 

project to help this adjustment. 


Service projections 15 years forward have been 

prepared by Personal Health to help inform 

decisions around hospital configuration in the 

Auckland region. 

A major part of the Auckland locality’s work has 

been to build a positive relationship with providers. 

In particular, its predecessor (North Health) was 

known for its acrimonious relationships with 

primary care providers, mostly caused by differences 

in interpretation of the North Health primary care 

contract. Now, the Auckland office has almost all of 

its primary care providers on the nationally 

consistent contract, and regular forums are held with 

primary care providers to oversee development of 

those contracts. 

Asian health is an emergent issue. The HFA 

contracts with Waitemata Health for Asian health 

support services to identify health care needs, 

provide access to health information, provide 

in-service and meet the Asian community’s 

health needs. 

Major achievements for personal health in Auckland and Northland locality 

Better provider relationships 

Primary care dispute resolved 

Long-term contract with 

Auckland Healthcare 

Service reconfiguration 

Regional Trauma Centre 

Northland Rural GP Consortium 

Plunket services 

Pacific Islands health 

The HFA established better relationships with primary care organisations and hospitals, 

greatly enhancing opportunities for increasing the role of primary care providers in 

prevention and management of chronic and acute diseases. 

Settled a long outstanding major claim from previous administration regarding ProCare’s 

claim for settlements under budget share arrangements. Agreement by ProCare to 

implement a programme for Pacific Islands peoples was a significant outcome of the 

negotiated settlement. 

Agreed to a 13-year contract with Auckland Healthcare, in which the HFA guarantees a 

decreasing revenue stream and Auckland Healthcare agrees to generate positive health 

or financial gains for the HFA. 

Moved paediatric neurosurgical services from Auckland Hospital to Starship. 

Moved dermatology from Auckland Hospital to Greenlane Hospital. 

15-year service projections described. 

Regional configuration process begun. 

Auckland Hospital established as regional trauma centre 

Developed to address locum coverage and Continuing Medical Education needs of 

rural GPs. 

Extra funding allocated to provide WellChild facilitation and support services. 

The HFA developed new child health services, and funded a mobile hearing testing 

service in the Auckland. 

Hamilton Locality 

Area served: Waikato, Taranaki, Bay of Plenty 

Total population: 678,000 


The Hamilton localities are characterised by: 

• Large sparsely populated areas. 

• A younger age structure than New Zealand as a 

whole, and a higher proportion of Maori than 

the national average. 

• Large proportions of families with young and 

school-aged children, a significant number 

headed by single parents. 

• Almost one-third of people aged over 65 live 

on their own. 

• Incomes within the region are lower than 

national average, indicating greater disparity 

between high and low incomes 


Rural health is a key concern as 40 percent of the 

locality’s population live in communities of less 

than 10,000. There is a high proportion of Maori. 

12

The hospital network in this locality is highly 

efficient. Health Waikato operates a ‘hub and spoke’ 

provider network with its four rural facilities 

(Thames, Tokoroa, Te Kuiti and Taumarunui) as 

the spokes, and Waikato Hospital the hub. Health 

Waikato is the second largest hospital in 

New Zealand and represents 10 percent of 

hospital funding. This hub and spoke ensures that, 

as far as possible, services are delivered where 

people live and all people have equitable access to 

specialist services. 

Thames Hospital has been in the spotlight with calls 

for a return to 24-hour, seven days a week surgery. 

The current service is 24 hours, five days a week. 

The HFA does not support a return to seven days, 

as the volume of cases from Thames admitted to 

Waikato over a weekend do not justify the increased 

costs. 

All hospitals in the region have made significant 

progress toward reducing waiting times through 

the booking system, becoming more efficient and 

reducing historical deficits. 

There have been substantial issues around the 

nature of primary care contracts from its 

predecessor, Midland RHA. In reviewing and 

modifying the contact relationships, we have 

preserved some of the very positive aspects and 

eliminated the negative. 

One good aspect is the extent of capitation. 

Capitation provides an incentive for doctors 

to manage themselves for the benefit of 

their population, rather than just collecting 

fees for services. About 75 percent of all 

doctors in this region are capitated. The result of 

capitation has been a change of practice to using 

nurses more and GPs less. We have continued to 

review and enhance the quality review 

programmes. 

The Hamilton office leads the renegotiations of the 

First Health contract. The contract is on a nationally 

consistent basis. Now, any surplus from managing 

pharmaceuticals can be measured, and applied to 

the purchase of health services, rather than being 

gathered as a private profit. 

Major Health achievements for personal health in Hamilton locality 

Essential dental care extended Meeting the needs for low-income adults over the entire region with more than 100 

dentists involved. 

New mobile dental service 

KidZNet 

Integrated child health pilots 

New Traditions - Rotorua 

Plunket WellChild services 

Abortion services 

Pharmaceuticals 

Catering for three new schools, and nearly 2000 children in the Western Bay area. 

Software development for child health information service. It is a provider-driven, joint 

HFA project & due to go live in February 2000. There has been interest from South 

Auckland, Wellington, Taranaki and Dunedin child health groups and IPAs wanting to 

use KidZNet system. 

New Traditions is a national site and has successfully integrated primary and secondary 

services. It is looking at specific projects across primary and secondary services. Rotorua 

has all but one GP as part of one IPA, which makes this possible. 

Moving towards one single national contract that will allow dollars to move to where 

people chose to go for their WellChild. There are a significant number of new providers 

introduced into this service. 

Midland women can now obtain an abortion within the region, with the extension 

of the service at Waikato and Thames hospitals and a new service at Tokoroa Hospital 

this year. 

Personal Health contracted 32 community pharmacies to provide greater and userfriendlier 

access. 

$2 million increase in oncology Allocated an additional $2 million to Health Waikato for 1572 chemotherapy treatments 

and 5508 radiotherapy treatments, to meet increasing demand. 

Maori Development Organisation 

The Midland region has two Maori development organisations - Poutiri Trust (Bay Of 

Plenty) and Tui Ora (Taranaki) leading the way toward better service co-ordination, 

access and quality for Maori. The Midland region also has the highest number of 

independent Maori providers reflecting higher population rations of Maori and iwi/ 

hapu structures. 


Wellington Locality 

Area served: Wellington, Manawatu, Wanganui, 

Hawkes Bay, Gisborne, and Wairarapa 



The Wellington office serves a diverse set of 

localities. It ranges from the urban, relatively 

well-off Wellington City to rural, poor Tairawhiti. 

There are several populations with a high 

percentage of Maori. 

The Wellington population is generally wealthier 

and healthier than the national norm. There are 

pockets, however, of considerable poverty and poor 

health status. Within Hawkes Bay and Tairawhiti 

there are particular areas that have a lower health 

status, due to the high proportion of Maori. 

These include the East Coast (95 percent Maori) 

and Wairoa (58 percent Maori). There are a large 

number of rural health centres in areas with 

declining populations and decreasing client 

numbers. 


The Wellington locality is most advanced with 

development of the analytical base of health 

services. The locality has completed, and seeks to 

consult on, a substantial review of its population’s 

health. The work is particularly comprehensive and 

takes health, and the costs of lack of health, down 

to the finest level of definition we have ever 

achieved. We are now almost able to tell the average 

health of a person depending on where they live. 

We expect this work, ‘Improving our Health in 

Wellington’ to be a substantial vehicle in guiding 

health purchasing. 

Specific hospital service issues include: 

• The Wellington area hospital plan for the 

Porirua/Kapiti Coast areas. Cabinet decisions 

regarding accident and emergency services at 

Porirua will cost an estimated extra 

$500,000 annually. 

• Hospital performance: HealthCare Hawkes Bay 

(financial viability because of depreciation 

costs); Capital Coast Health (performance 

issues); and some small HHSs such as Wairarapa 

Health (clinical viability issues). 

• Rural hospital service issues need resolving in 

Horowhenua, Taihape, Wairoa and Raetihi 

regions. 

• We have ensured the viability of Capital 

Coast Health by contracting for higher 

prices beginning next year. This was done 

to facilitate the new hospital and help with 

the current financial situation of Capital 

Coast Health. The locality carries a $5 million 

risk next year, which should be covered from a 

re-allocation of money from the tertiary 

adjuster. 

The Government is scoping an integrated care 

initiative for the Porirua/Kapiti area. The initiative 

is being led by the MoH. 

Pacific Islands health services are being developed 

in the region and will continue to expand. 

There are six hospitals in this region. If a hospital 

network were devised from scratch it would 

probably have the same number, but with a different 

arrangement of services. 

14

Major achievements for personal health in Wellington locality 

Models of care pilot with Wellington 

IPA and Capital Coast Health 

Dental health 

Primary Maori Health 

Te Puia Springs 

Child health 

HHS financial solvency 

Medical/surgical initiatives 

An integrated sexual health service 

in the Wellington region 

Focus on chronic obstructive pulmonary disease and congestive heart failure - two major 

causes of acute medical admissions. 

The new mobile children’s dental service for the Wellington region is to start soon. 

Dental health promotion service in Wanganui, Wellington, Hawkes Bay, Tairawhiti 

and the Manawatu. Contracts with a range of providers including four Iwi contracts. 

An Oranga Niho contract for Maori teenagers and low income adults in the Hawkes 

Bay region. 

A primary medical service in the Wairarapa by a Maori provider 

Transfer of health services at Te Puia Springs to the local iwi based health provider, 

Ngati Porou Hauora. 

Provision of paediatric surgery outreach clinics. 

Development of child health facilitation and support services in Wanganui. 

Capital Coast Health, Good Health Wanganui and MidCentral Health are now on the 

road to solvency. 

Contract incentives for Capital Coast Health to work more closely with primary care 

organisations on the management of people with chronic diseases. 

Utilisation of Wairarapa Health’s spare capacity to provide general surgery operations. 

Significant reduction in waiting times for elective surgery at Hutt Valley Health and 

Wairarapa Health. 

Free access to young people between the ages of 19-25 with a community services card. 

South Island Locality Offices 

Area served: Nelson/Marlborough, Canterbury/ 

Westland, Otago/Southland 



• Most rural areas are slowly losing population 

• Dunedin, Christchurch (and its commuter belt), 

Nelson/Marlborough and the Wakatipu basin 

are growing. The West Coast is neither 

increasing nor decreasing. 

• Small rural population is scattered over vast 

territory meaning access problems. 

• Low Maori and Pacific Islands population. 

• Lower health status in inner cities and poor 

suburbs, the West Coast (especially Buller), 

and in some small rural towns. 

• There are more elderly in the South Island than 

other localities. 


The South Island locality is characterised by 

declining population, other than Christchurch, but 

it covers a large regional area. This means the 

southern region faces different management 

problems. The region operates through two offices, 

and manages a service budget that isn’t growing as 

fast as that of other offices. 

There are substantial viability issues around rural 

hospitals. HHSs have signalled their wish to exit 

from at least two, possibly six, rural hospitals. 

The long-term viability of the newly established 

Central Otago Community Trust is an issue, as is 

the availability of some GP services in rural areas. 

West Coast, Nelson /Marlborough, Queenstown 

Lakes and Invercargill areas have economic scale 

problems because of their rural nature and small 

populations. 

An ageing population also poses challenges. 

There is increasing pressure to fund palliative care 

services more fully, reflecting a nation-wide trend. 

Further, there is growing pressure on the cost and 


volume of community service, as more people leave 

hospital earlier and with more complex problems. 

In addition, acute medical volumes continue to 

grow faster than population, especially in 

Christchurch, particularly in respiratory, cardiology 

and general medical. 

The South Island has been wrestling with 

a significant budget problem. Personal Health 

has a significant shortfall on purchasing 

emergency department attendances at Healthcare 

Otago and Southern Health ($1.3 million and 

$3 million). 

Christchurch is emerging as the major tertiary 

institution. Clinical viability of specific medical and 

surgical services (e.g. neurosurgery at Healthcare 

Otago, ophthalmology at Southern Health) is an 

issue, largely because of retention and recruitment 

of clinical staff in this area. 

Waiting times in surgical services are still high in 

some specialities. 

Major achievements for personal health in the South Island locality 

Pegasus contract 

Community trust contracts 

Emergency ambulance service 

for whole South Island 

New community hospice 

Director of Rural Health 

Innovative support packages for 

rural health centres 

Pacific Islands health service 

Integrated care project - 

Marlborough 

Health action plans 

An innovative contract including a project to manage acute demand growth. 

Put in place with new community trusts in the Waitaki, Central Otago, Gore and Balclutha 

areas, following the withdrawal of service provision by Healthcare Otago and Southern 

Health. 

A three-year emergency ambulance contract with the Order of St John close to finalisation, 

including delivery of the primary response in a medical emergency (PRIME) scheme to 

assist in provision of emergency services in geographically remote areas. 

Established by the Nelson Hospice Trust with the co-operation of Nelson Marlborough 


Dr Pat Farry was appointed to this post earlier this year. 

The HFA has worked with district councils, health trusts and centres to locate new GPs, 

build a locum database and provide support packages and retain general medical and 

nurse practitioners. 

Additional child health funding was taken up by a new organisation, expanding services 

for the Pacific Islands community in Christchurch. 

The HFA is working with Marlborough Health Trust, the Nelson Marlborough Health 

Services and the community on various projects to improve health services in the area. 

The HFA is working with South Link Health on developing diabetes and cardiovascular 

disease plans. 

16

Our Focus 

Maori Health: Action Oriented 

Strategy 

Issues 

Disparities in health status are a major concern and 

our focus is evident in the work being done in 

Maori health. We have been focusing on identified 

geographical areas (such as larger Maori populations 

with lower socio-economic status) and on particular 

service areas where Maori have poorer health. 

The total Maori population is 523,365 (nearly 15 

percent of the population). Some localities are 

densely populated by Maori where health status is 

particularly poor - notably Wairoa, South Auckland, 

East Coast, Hutt Valley, Northland, Bay of Plenty. 

Many of these areas also have significant rural 

health issues. Funding plans for these localities 

emphasise the higher numbers of Maori, who often 

have greater need for more appropriate services in 

a diversity of settings - marae, Maori health clinics, 

mobile services. Often the diversity of providers 

needs to be greater to promote choice and access 

so in these areas we have worked hard to ensure 

the number of Maori providers is greater. 

Our funding plan gives full regard to HFA Maori 

health policy of: 

• Greater Maori participation at all levels of the 

health sector 

• Mainstream enhancement 

• Maori Provider development 

Our projects place a heavy emphasis on Maori 

health gain and in particular the eight key priority 

areas identified and endorsed by the HFA Board. 

The key priority targets relevant to Personal Health 

are: immunisation, diabetes, oral health, hearing 

and asthma. The choice of diabetes, asthma and 

oral health for disease management programmes 

was driven by these key priorities. Plans for 

improvement in hearing and immunisation for 

Maori are being driven through the child health 

strategy. 

We are acutely aware any plans for improving Maori 

health status must address the continuum of care - 

preventative programmes and improving access to 

primary and secondary care. This impacts on the 

way we fund and support preventative health 

education (with the Public Health group); 

the funding of primary care (GP services, 

pharmaceuticals, nursing services, sexual health, 

WellChild services); and the access and treatment 

of Maori in secondary care. We are seeking to 

increase Maori access to secondary care to ensure 

necessary treatment in some areas (complex 

diabetes treatment, cardiac surgery) but in others 

we are aiming to reduce hospitalisation (acute 

admissions for asthma). 

Personal Health’s Action 

All the plans developed integrate cultural factors 

that improve access, equity, effectiveness and 

ultimately health outcome. Examples of these 

include: 

Preventative Programmes 

• Supporting smokefree and smoking cessation 

initiatives (which impact on cancer, respiratory 

conditions, diabetes, heart disease, child health 

and life expectancy). 

• Increasing funding to Maori providers to 

provide education in nutrition, exercise, oral 

health, smoking cessation. 

• Ensuring programmes have implicit Maori 

health gain targets, such as the programmes for 

Hepatitis B, breast screening, cervical screening, 

and diabetes. 

• Integrating health and education services with 

clinically based services. 

Primary Care Programmes 

• Integrating the role of Maori providers. 

• Development of funding formulae which 

incorporate a measure of deprivation and 

ethnicity considerations. 

• Promoting better integration between IPAs, 

HHSs and Maori provider organisations, 

e.g. the Auckland Healthcare/Ngati Whatua 

joint venture for Hepatitis B screening 

• Supporting workforce development to train 

Maori in key areas (child health, nurse 

educators). 


Secondary Care Programmes 

• Ensuring Maori need is identified in an 

equitable way through Access Criteria for 

surgery (Booking Systems project). 

• Identifying Maori utilisation of secondary care 

services and comparing this to prevalence of 

disease in the population. 

• Paying a Maori Health Adjuster to hospitals to 

provide an incentive to improve service delivery 

to Maori, and contracting for quality measures 

with explicit Maori health requirements. 

Improving Access to Services 

• Family Start programme targeting Maori in key 

localities. 

• Maintaining the important role of Maori 

Community Health Workers and Support 

Workers in health care provision and advocacy 

for Maori whanau. 

• Ensuring Maori needs are met through 

telephone helplines (Healthline, Plunketline, 

Maternity Helpline). 

• Improving the way information is disseminated 

to Maori. 

Monitoring Service 

• Identifying and monitoring resource allocation 

for Maori. 

• Evaluating quality audit programmes measuring 

the effectiveness of services for Maori. 

In 1999/2000 Personal Health is reviewing 

maternity and child health services. 

• Collecting ethnicity data to support analysis for 

decision making and resource allocation. This 

is a significant area for development through 

primary care, child health, immunisation and 

disease management projects. Currently we are 

able to report ethnicity specific information for 

most hospital services but the error rates (Maori 

recorded as non-Maori) in the figures produced 

can be as high as 50 percent in some hospitals. 

• Feedback and participation of Maori (at the 

levels of governance, provider and consumer) 

in projects provides direct evidence of service 

effectiveness. This will produce better 

outcomes for Maori. Involvement of Maori 

(both internal and external to the HFA) is a 

critical component of our methodologies in the 

process of shaping future-funding models. 

Pacific Island Health: Growing 

and Young Population 

Issues 

The estimated population of 227,000 (6 percent of 

3.8 million) is young and diverse with a projected 

growth to 600,000 (12 percent of 4.8 million) 

by 2051. It comprises Samoan (50 percent), 

Cook Islands (22.5 percent), Tongan (15.5 

percent), Niuean (9.0 percent), Fijian (2.0 percent) 

and Tokelau (1.0 percent). Some 58 percent of 

Pacific Islands resident in New Zealand in 1996 

were born in New Zealand. Some 80 percent of Pacific 

Islands people live in cities, mainly Auckland. 

Pacific Islands people often have lower health status 

than Maori with different behavioural patterns from 

the mainstream population, requiring a different 

approach. The four member HFA Pacific Islands 

health team is based in Auckland and Wellington. 

The socio-economic status of Pacific Islands people 

is low. The strategy ‘For Pacific by Pacific’ is based 

on these facts and the priority areas are: child and 

youth, maternity, primary care, and medium to 

long-term preventative health. 


• In the past year new child services targeting 

Pacific Islands children have been purchased 

in Auckland, Wellington, Christchurch and 

Hastings. A mobile hearing testing service in 

Auckland (targeting Pacific Islands children) 

has been bought from the National Audiology 

Centre and has been operational since July 

1999. Child health and primary care services 

have been bought in Newtown (Wellington) 

and the Hutt. Provider organisations have been 

established in Christchurch, Hastings and 

Hamilton. 

• Joint ventures between Maori and Pacific 

Islands providers for services targeting children 

have been entered into in west and south 

Auckland, Porirua and the Hutt. 

• Multiple initiatives are aimed to produce benefit 

for the large numbers of Pacific Islands people 

in South Auckland. 

18

Child Health: High Levels of 

Activity 

Issues 

New Zealand has one million children aged 14 or 

younger, with 57,000 babies born annually. 

Disparities of health outcome for Maori and Pacific 

Islands children are well documented. The Child 

Health Strategy (1998) and Strengthening Families 

Strategy provide the basis to address disparities and 

improve all children’s health. 


Child Health Information System 

Quantitative information on children’s health is not 

available in any easily retrievable form. 

• Personal Health has been developing the Child 

Health Information Strategy (CHIS) which will 

be implemented progressively. Some aspects 

have already begun, such as the perinatal 

information system and immunisation coverage 

(using HBL data) 

• The KidZNet pilot is underway, involving 

information transfer between providers. 

This will govern the way a national information 

system is established. National consistency will 

be ensured during implementation between 

providers and a range of systems. 

WellChild and Youth Service 

The key issues for WellChild are access and 

coverage. 

• A technical advisory group of clinicians, 

providers, and Personal Health is considering 

future directions for WellChild services, 

including the possible linkage of funding 

mechanisms for WellChild and immunisation 

services. 

• Integrated child health service approaches 

(facilitating co-ordination and information 

sharing between providers) have been 

developed in West Auckland, Rotorua, 

Hamilton and Christchurch. 

• The development of a youth strategy focusing 

on sexual and reproductive health will 

commence in 2000. 

Family Health Initiatives 

Strengthening Families is a joint initiative to 

improve outcomes for children and young people 

at high risk. There are three programmes: Family 

Start, Local Co-ordination and Preventative 

Initiatives. 

• Personal Health is meeting regularly with 

health, education and social services policy staff 

to ensure effective national implementation. 

• Personal Health is the lead purchaser on a 

number of programmes. Four further 

programmes have been put in place by Personal 


• In some areas there has been resistance to local 

co-ordination programmes. Personal Health is 

developing strategies accordingly. 

Rural Health: Continual Focus 

Issues 

Retention and recruitment of doctors in rural areas 

is one of the most significant problems facing the 

health sector. Rural communities, particularly 

small ones, have difficulty attracting and retaining 

health services. They can often support only one 

doctor who is constantly on call, isolated and has 

difficulty finding locums. The doctor-to-patient 

ratio in rural areas is lower than that of other areas. 

On-going professional development is critical for 

the safety of practice and to overcome professional 

isolation. 

Rural communities have specific needs which must 

be taken into account: the disparity of health status 

of Maori; lower socio-economic groups; people 

with disabilities who require assistance; children 

and older adults; and the high injury rate. 

Access to services by Maori is a particular concern. 

For non-Maori, the rural health status measures 

compare favourably with urban. 


We have developed initiatives over the past year to 

address these problems. These include: 

• Improving the retention of health professionals 

through the change from the rural bonus to the 

rural ranking scheme; expansion of the Centre 

for Rural Health to a national role and the 


funding for Rural Directors. In the North Island 

there is a specific requirement to forge links and 

work to improve the health of Maori. 

• Developing appropriate skills and knowledge 

among rural professionals to improve Maori 

health disparities, through modification and 

review of existing contracts. 

• Introducing the PRIME (Primary Response in 

a Medical Emergency) programme in the North 

Island to improve access to treatment in rural 

medical emergencies. This has involved funder 

collaboration (HFA and ACC) as well as 

provider (ambulance services, GPs and nurses) 

collaboration. 

• Encouragement and support of rural 

practitioners to develop networks and multidisciplinary 

teams to maximise the benefits of 

the available resource. 

Service Gaps: Being Addressed 

Issues 

The budget bidding process, carried out in 

November, highlighted (to a greater level of detail) 

service gaps. Identifying these gaps and identifying 

a way to meet the needs of our people is a key 

challenge for Personal Health. Sometimes not 

meeting needs means waste and inefficiency as 

more is spent treating later. Often it means lost 

quality and quantity of life. 

The gaps that we have identified include: 

Immunisation of Maori and Pacific Islands Children 

Only 45 percent are currently immunised and it 

will require a 55 percent increase in funding to 

target the hard to reach. Existing contracts are not 

meeting demand. 

Medical Surgery 

Increased funding is required for emergency 

departments to reduce waiting times to acceptable 

levels. Increased oncology volumes has led to 

increased vascular surgery requirements. Radiology 

volumes need increasing. There is a shortfall in 

oncology radiation therapy. Renal and urology 

inpatient services need additional resources. 

Medical Surgery- elective 

Funding required to sustain level of elective surgery. 

Palliative Care 

Fully funding hospices. 

Laboratories 

Ensuring consistent pricing of outpatient 

laboratories across New Zealand. 

Maternity and Neo-natal 

Infertility services (including diagnostics). 

Oral Health 

Dental services for low income adults. Increase in 

utilisation for children and adolescents. Dental 

education and examinations for pregnant women 

and mothers of pre-schoolers in at risk areas. 

Dental Brush-ins for pre-schoolers in at risk areas. 

Regional Inconsistency 

Regional inconsistencies also need addressing. 

Auckland funds sexual abuse services, Wellington 

does not. Auckland provides good access to 

infertility services, but they are poor elsewhere. 

Community referred radiology is restricted to 

Community Service Card holders in Wellington 

and the Hutt Valley. Insulin pumps are funded in 

some areas only. Some areas have no hospices, for 

example the Midland region. Emergency dental 

services are not available in Hawkes Bay or the 

Hutt Valley. 

Personal Health’s action 

• We are prioritising what we can do with the 

available money. For instance, we are moving 

very quickly on some key immunisation issues 

(discussed below). 

• Medical surgery is being prioritised to those 

most in need, who can benefit from the surgery. 

• Clinical and service reviews are revealing some 

areas where substantial changes mean we can 

deliver more, for less money (eg. the developing 

dental strategy). Many of these issues are 

discussed further under clinical management. 

• We continue to identify gaps by mapping our 

service coverage document against locality 

contacts, by service reviews and by locality 

needs assessment. 

20

Working with Providers 

Hospitals: Purchasing Strategy 

and Issues 

Issues 

One of the biggest areas of our work ($3.2 billion 

from all operating groups) is shaping relationships 

with hospitals. The services provided are complex, 

significant and one of the traditional areas of service 

provision. The institutions are well resourced, 

complex and in considerably better order than a 

few years ago. 

Before Personal Health was established, the 

relationship between purchaser and provider was 

acrimonious, time consuming and negative. 

More recently issues about hospital purchasing 

strategy and issues have been debated and analysed 

in joint technical working groups before being 

escalated for policy decision making. 


We have implemented ‘relationship contracting’. 

Both the HFA and hospitals explicitly recognise our 

interests are indelibly linked and are working 

together to achieve the wider goal of benefit to 

patients. We try to put our differences in a strategic 

contracting context, although there is significant 

tension for hospitals and purchaser to achieve their 

respective goals. 

In operational terms that means: 

• Evergreen contracts (lasting forever) versus 

annual negotiations. 

• Continuous improvement of services (instead 

of once-off, forced changes). 

• Commitment to joint problem resolution and 

strategic planning. 

Some hospitals have found it easy to work in this 

environment. Others haven’t. Those that haven’t 

are often under considerable pressures, such as 

substantial capital investment programmes, 

which bring them up against ownership interests. 

In short, the sector is still learning to work in a 

co-operative way. 

The most controversial element is about money, as 

always. Hospitals are paid from a national price 

book that has prices for different types of operations 

described in a standard unit (called a cost weight). 

Important adjustments to the standard cost weight 

are payments for complexity (e.g. Starship) and 

payments for rurality (e.g. Wairarapa hospital). 

The sector faces important, unresolved questions: 

• Prices should be higher for mental health, lower 

for personal health 

• Capital costs should be included, but how 

• A price path should be paid, but at what level 

A significant further issue is the growth in acute 

medical volumes, an issue that needs to be resolved 

by primary care, but working in partnership with 

hospitals. 

Primary Care: Well Advanced 

Issues 

This is the public’s first point of contact with the 

health sector. The current delivery of care is based 

on an episodic approach responding to patient 

demands. There is an increasing demand on 

services, which have historically grown at 5 - 10 

percent annually, without demonstrable health 

gain. Technological advances, ageing population 

and shorter hospital stays are increasingly requiring 

a greater level of care. 

Primary care expenditure is $1.26 billion. Much of 

this is indirect spending through referred services. 

In the current financial year Personal Health is 

forecast to spend $631 million on pharmaceuticals, 

$251 million on General Practice subsidies 

(including practice nurses), $178 million on 

laboratory tests, $20 million on primary care 

organisation services, and $10.6 million on 

immunisation. 

There is a lack of co-ordinated and monitored care 

between providers - between hospital and primary 

care and between different primary care 

providers. Good information is a key to addressing 

this issue. 

The HFA has agreement from the sector on 

specifications for shared information. We regard 

this as a major accomplishment. 


Privacy issues are significant. We plan to consult 

with the public on the increased use of National 

Health Indicator (NHI) on health data and 

appropriate processes to ensure privacy legislative 

obligations are met. The consultation is made up 

of three parts: 1) introducing NHI numbers onto 

all claims; 2) explaining to the public the purpose 

and use of ‘individual data’ (and in specific purposes 

when the HFA will have access to ‘identified’ data); 

3) the proposed processes to be used for the 

collection, storage and access of confidential patient 

information. 


Our gains in this area are well beyond what we 

believed possible. 

• Relationships with the sector have improved 

over the past year with the new focus on 

co-operation and openness. Almost all GPs in 

primary care organisations have moved to the 

new national contract. 

• The new national contracts provide for a 

consistent information schedule, passive 

enrolment moving to active enrolment, crossmatching 

of registers and Maori quality 

standards (in other words, all the infrastructure 

to move to population based primary care). 

• Contracts with IPAs include action plans for 

additional services, particularly for Maori. 

These will address areas of high health need or 

deliver important health outcomes. 

• Establishment of a joint working party to 

analyse issues relating to capitation. 

• A range of integration projects - Personal Health 

has some 20 projects running with greater or 

lesser degrees of integration. 

We are consolidating on moves to greater national 

consistency: 

• Electronic claiming - by July 2000. 

• Internal Systems - making sure we can monitor 

and implement contract requirements. 

• NHI Implementation - for all claims, including 

ethnicity on General Medical Subsidy (GMS) 

and immunisation. 

A key issue is consultation on privacy of 

information issues. A work-stream is established 

and we are ready to discuss the issue. 

Telephone Advice: A New Concept 

in New Zealand 

Issues 

Telephone triage is a relatively new concept built 

on the system introduced by the United Kingdom 

Labour Government to the National Health Service 

(NHS). Telephone triage services assess the 

urgency of callers’ health problems and advise 

which service they should contact (such as 

ambulance, emergency department, GP, or selfcare) 

plus the appropriate timeframe within which 

this should be done. The intention is to reduce cost, 

by treating the matter over the telephone, and to 

reduce morbidity by getting those in need to GPs 

or emergency services faster. 

Patients are connected to the appropriate service 

and, with the patient’s agreement, can have the 

information collected during the call forwarded. 

The assessment and advice process are supported 

by a computer-based system designed to identify 

the cause of the complaint that is riskiest for the 

patient (rather than the most common or most 

likely cause). 


The provider of New Zealand’s telephone triage 

system, Healthline, is a partnership of High 

Performance Healthcare (HPH) and Access Health. 

St John’s Ambulance is also part of the group. HPH 

is based in Australia and Access Health provides 

nurse telephone triage services as part of NHS 

Direct in England. Between them they have 

substantial experience at providing this kind of 

service. 

Healthline will provide a telephone triage service 

to 650,000 people in four identified pilot areas 

(Northland, Gisborne/East Cape, Canterbury and 

West Coast/Buller). 

Pharmacy: Needs to Adapt 

Issues 

The current regulatory environment is outdated. 

Pharmacists no longer produce medicines and are 

largely reduced to dispensing pre-packaged 

product. The current system is costly for both 

pharmacists and us. Pharmacists are strongly 

unionised by the Pharmacy Guild, which continues to 

promote the small business owner aspect of pharmacy. 

22

Contracts are currently provider-focused with poor 

links to health gain. The technical skills of 

pharmacists are under-utilised. 


• We have significantly cleared the backlog of 

contractual issues, including settlement of 

outstanding maximum dispensing queries and 

the southern pharmacy contract price pool 

reviews for 1998/99, 1999/2000 and 2000/01. 

• We have driven improvements in HBL payment 

processes, and are close to implementing 

electronic claiming. 

• We are working with the sector to identify roles 

for pharmacy to make use of their clinical skills 

in patient medicine management. 

• We have linked development of a pharmacy 

strategy with developments in integrated care 

and primary care strategies. 

Laboratory Contracts: Poised to 

Move Forward 

Issues 

The HFA has consulted on strategies aimed at 

managing expenditure on laboratory tests. The 

reasons for wanting to introduce change include: 

• Lack of evidence that prices are at the correct 

level and some evidence that they are too high. 

• Lack of competition in the community 

laboratory sector over price. Sonic Healthcare, 

an Australian company, now owns 65-70 

percent of the New Zealand community 

laboratory sector. 

• Regional discrepancies in availability of tests 

and standard contract terms and conditions, 

including quality requirements. 

• Increasing utilisation at a higher level than the 

increase in health funding. Expenditure has 

increased from $116 million (1993/94) to 

$172.5 million (99/00). 

• A desire by hospital laboratories to enter the 

community laboratory business. 

Developing a strategy has not been easy. None of 

the RHAs managed. We have, and we are poised to 

implement it. 


• Developed and implementing strategies to 

manage demand, driven by contracting with 

primary care organisations and tendering for 

supply of a best practice advisory service. 

• Consultation on comprehensive supply side 

strategies is complete and is waiting on the new 

Government before proceeding. As part of that 

strategy, we are working towards opening the 

market to competition from HHS laboratories. 

• There is no single answer - each case will need 

a tailored solution. 

Maternity: Direction Correct but 

Improvements Required 

The National Health Committee’s maternity 

services review this year aimed ‘to consolidate, 

refine and render consistent what is already a 

workable and potentially equitable structure’. 

The recommendations made by the NHC did not 

reverse the existing maternity framework. 

Issues 

The major issue is poor relationships between 

providers. Access is also an issue - some women 

have difficulty accessing unbiased information on 

maternity services. Emergency specialist services 

for women in rural areas also need to be addressed. 

The HFA has concerns about poor performance by 

some Leader Maternity Careers (LMC) and some 

hospitals. 


• We are exploring the development of regional 

primary maternity networks to provide 

information to patients and manage 

relationships with other providers. 

• We are finalising referral guidelines for specialist 

services 

• We have established a maternity ‘Roadside to 

Bedside’ focus group, and are addressing 

emergency services for rural women 

• We are finalising a comprehensive audit 

programme that complements the LMC audit 

programme and the cultural audit currently 

being conducted on all hospitals. 


Accident Insurance Reform: 

Significant Risks 

Issues 

The Accident Insurance Act has required us to 

identify costs to insurers of accident services. 

The reform has several significant risks, all of which 

get carried by Personal Health: 

• Risks of providers shifting accident costs from 

ACC to the HFA due to higher compliance costs 

associated with lodging claims with ACC. 

• Comparability of the levy paid by ACC ($221 

million, 1999/00) and the actual costs of 

delivering accident-related public health acute 

services. 

• Poor quality of information collected and 

managed by hospitals to inform the purchase 

of accident related services. 

We endorse the direct purchase by an accident 

insurer of primary based services, except for 

pharmacy and laboratory. The Crown currently 

has exemption under the Commerce Act for fixing 

pharmaceutical and laboratory prices. The Crown 

gains negotiating leverage by including those 

volumes related to accidents. 

Future options for funding accident-related 

treatment must take into account the following 

issues: 

• Transaction costs for providers and funders 

increase in direct relation to the number of 

purchasers and purchasing frameworks. 

• Hospital information management systems are 

in transition from bulk purchasing (which did 

not require detailed information on the tracking 

of individual patient costs). Changes putting 

pressure on hospital information systems must 

be managed with the sector, giving clear signals 

on information needs. 

• The public is confused about their entitlements, 

particularly the variation between accidents and 

illnesses. Changes varying the criteria and 

access to publicly funded services must be 

clearly communicated. 


We are working to improve the tagging of accidentrelated 

scripts and tests to ensure information on 

actual volumes is improved. Another priority is 

improving the transparency of information on the 

cost/volumes of accident-related treatment to 

enable informed decision making on future funding 

of acute accident treatment. 

We are improving the information on accident 

volumes/costs for the calculation of the public 

health acute services levy through: 

• Surveying compliance costs to assess the 

additional compliance costs imposed on 

hospitals and assessing funding options. 

• Monthly communication with hospitals to 

ensure information in implementing the new 

regime. 

• Analysis of hospitals’ routine reporting to 

calculate the Public Health Acute Services Levy 

for 2000/01. 

Quality: Transforming the Sector 

Issue 

A focus on the quality of provision of health services 

has become a feature of health systems 

internationally. A culture of quality and selfimprovement 

is rapidly being established. 

Some argue that the health sector is the sector 

where up-to-date ideas about quality management 

have gained least traction. Partly, this is because of 

the sector’s reliance on management by medical 

colleges. 

There are very major issues in quality improvement. 

Those issues include: the setting of standards for 

all providers; continuous quality improvement; 

provider self-improvement programmes; and 

credentialling of providers. 

The future thinking quality programmes under 

development internationally, and being kick-started 

in Personal Health, are evidence-based health 

indicators and monitoring programmes. The belief 

is the development of these clinical indicator 

frameworks will provide territory for radical 

transformation of clinical services in the future. 


Our key objectives during the past year have been: 

• Development of initiatives to respond to major 

quality and safety issues which will arise, with 

24

a budget of $1.65 million (in addition to the $2 

million allocated to investigate Gisborne 

pathology services). 

• Planning the implementation of the Health and 

Disability Sector Standards. 

• Developing evidence-based quality in hospitals. 

• Developing quality improvement and 

purchasing strategies for specific services 

(particularly Pharmacies, WellChild, and 

Maternity Services). 

• Managing the investigation into cervical 

screening/laboratory issues in Gisborne. 

Sector Standards Being Developed 

Issues 

These standards will provide for assessment of 

providers against a common set of safety and quality 

requirements. We anticipate the standards will be 

a legal requirement, initially applying to services 

subject to licensing/regulation requirements 

(mainly residential or in-patient/out-patient 

hospital services). 

Parts of the standards have significant short/ 

medium term cost implications, according to 

providers (mainly hospitals). Cost implications are 

likely, but there is insufficient information available 

to enable us to estimate this accurately. Providers 

state that the costs are in the tens of millions. 


Providers have a contractual obligation to use 1999/ 

2000 as a year for planning, in turn we have 

developed an evaluation programme. By May 2000 

we will have comprehensive national information 

about the current compliance of HHSs and the time/ 

resources required to achieve compliance. 

This information will be fed into our sustainable 

pricing projects, to ensure the cost of quality has 

been adequately considered. We anticipate using 

this approach to evaluate other providers, including 

hospices and Children’s Health Camps. 

We have been closely involved in the development 

of the Sector Standards, and will continue to work 

with the sector to develop the process for 

credentialling designated agencies, and application 

of the standards. It is essential these issues are 

worked through in close consultation with all 

affected parties in order to achieve the standards’ 

potential. We have arranged for a discussion 

session with a Health and Disability Sector 

Standards panel to be on the agenda of the Evidence 

Based Quality Workshop (see quality improvement 

activities in HHSs also). 

Evidence Based Quality in HHSs 

Issues 

Consumer Assurance 

Progressing the ability of HHSs to listen to the voice 

of the consumers, using methods including: 

• Consumer advisory groups. 

• Customer satisfaction surveys. 

• Complaints management. 

Reducing Errors and Increasing Safety 

• Development and improvement of healthcare 

safety reporting systems. 

• Providing for timely standardised reporting of 

sentinel and adverse events to inform central 

agencies and maintain public confidence. 

Health and Disability Service Safety Standards 

• Compliance by all HHSs completed before July 

2002. 

Infection Control 

• Improvement in systems that protect patients 

and healthcare workers. 

Healthcare Workforce 

• Workforce planning. 

• Retention and recruitment. 

• Clinical risk management. 

• Credentialling systems. 

Quality Oversight 

• Making quality explicit - clear aims for 

improvement, improving processes and 

eliminating waste. 

• Fostering evidence-based practice. 

Advancing Quality Measurement 

• Standardised measures to track healthcare 

progress in clinical outcomes and indicators. 

We have undertaken a substantial programme of 

quality improvement activities with HHSs over the 

past year, to articulate the quality imperatives for 


medical and surgical secondary/tertiary public 

providers, and to initiate projects addressing 

national deficits in systems fundamental for safe 

clinical care. 

We have worked closely with the HHSs and 

contracted project teams. Audits have been used 

to evaluate the current activity within each HHS 

and the results have been drawn together on a 

national basis. They are being used for further 

discussion about quality improvement activities 

which can be planned on a national and local basis. 

Key projects and achievements include: 

• Responding to the Stent Report on Canterbury 


• Reviewing the credentialling of medical 

practitioners. 

• Reviewing incident reporting systems. 

• Auditing complaints management systems. 

• Ongoing audit of acute admissions. 

• Participating in the review of HHS consumer 

satisfaction surveys. Further details of each 

project are given below. 

Quality Improvement Activities in Non HHS 

Providers 

Pharmacy 

A comprehensive national pharmacy audit has been 

implemented with the introduction of new 

pharmacy contracts (from October 1998) built on 

evolution and education. The aim is for continuous 

improvement of pharmacy services. We want to 

contribute to quality improvement, maximise 

appropriate claiming of the pharmaceutical benefit 

and offer support to pharmacies in meeting quality 

standards. 

Child Health 

We are working jointly with Children’s Health 

Camps (CHC) to evaluate their services against the 

Health and Disability Sector Standards, and a survey 

of expectations of those who refer children to health 

camps. This work will significantly contribute 

towards the development of a clear strategy for the 

development of services provided by CHC. 

It will be completed by March 31, 2000. 

In early 2000 we will be evaluating (with providers) 

the effectiveness of the new money allocated to 

WellChild services earlier this year. This will 

complement the development of national standards 

and specifications, which will be supported by a 

comprehensive review of the services currently 

provided by WellChild providers. 

Maternity 

An audit of the cultural appropriateness of 

maternity facilities for Maori is underway. 

This issue was raised by our consumer satisfaction 

survey (completed mid 1999) and the survey 

carried with the NHC review. It is due to report in 

April 2000. 

Youth Health 

We have completed an audit of the One Stop Shops 

in the Wellington region of the HFA, which will 

contribute towards the development of improved 

contracts and a wider youth health strategy. 

There are two key activities to support the 

programme: 

1. MEDSAFE is auditing community pharmacies 

against the criteria of the Pharmacy Quality 

Audit (PQA). The HFA, MoH and the 

Pharmaceutical Society jointly fund these 

audits. 

2. HBL is monitoring claiming profiles, pharmacy 

feedback reports and on site selected audits. 

26

Clinical Issues and What We are Doing 

Waiting Times: Patient Focused 

Care 

Issues 

The waiting times project is an innovative and 

international first, a project to bring order to one 

of the grey areas of health management. 

Historically, decisions about who gets elective 

surgery have been poorly prioritised and sometimes 

distorted by relying on individual judgement or a 

specialist’s power in a hospital. The project puts 

nationally consistent systems in place, based on 

clinical criteria, to make sure that those who most 

need surgery get it first. 

Correct ordering of priority means that any 

additional money that comes into elective surgery 

in the health sector does the most good possible. 

The principles of the project are as follows: 

• Patients should know when, where and what 

treatment is available to them within a fixed 

period of time. 

• Everyone, regardless of location, is entitled to 

the same level of service to address the same 

level of need and ability to benefit. 

• Timely access to first assessments and services, 

and elective services prioritised on a fair, 

transparent and consistent basis nation-wide is 

required. 

There is now significant acceptance of the project 

by clinicians and providers. Major system 

implementation has taken place. Great effort has 

gone into developing nationally consistent criteria. 

Draft national clinical priority tools are currently 

being circulated. 

The waiting times project raises a number of 

important ethical issues about urgency of need 

versus ability to benefit. In practice, however, 

clinicians take a practical view of what needs to be 

done in developing the clinical priority criteria. 

We are in the early phase of development so the 

monitoring and evaluation aspects are important. 

Diagnostics and some follow-up checks are being 

devolved to primary care, leaving money and time 

for hospital clinicians to improve further the 

elective surgery situation. 


The formation of clinical working groups draws 

on professional and patient groups to develop 

nationally consistent prioritisation tools to: 

• Score new patient inflows. 

• Re-score patients scored under regional tools. 

• Adjust local access thresholds to the new 

scoring system. 

• Progress from regional use of tools to national 

consistency. 

Our progress has been faster than anticipated for 

the implementation of the clinical criteria. 

There has been a substantial commitment from the 

medical community to development of these tools. 

We have developed a robust strategy to measure 

waiting list outcomes, using booking system data 

to ensure alignment with hospital need and capacity 

issues, determining more accurate financially 

sustainable thresholds by hospitals. 

In addition, provision of audit and monitoring 

processes will ensure quality improvement in 

hospital data collection systems. 

The system is not fully developed. We are now able 

to look up and down the country to identify the 

hot spots. We still do not fully understand the 

patient flows enough to give a firm view on the 

gap between what we currently are able to purchase 

(the financially sustainable threshold) and what we 

would like to purchase (the clinically sustainable 

threshold). 


Progress to Date 

Patients Waiting for Surgery 

Number of patients on inpatient waiting lists 

The number of patients waiting for 

surgery has decreased. This is due to 

accurate data collection and active 

management of the patients between the 

primary and secondary sectors. 

100,000 

80,000 

60,000 

40,000 

20,000 

0 

Jun 96 Jun 97 Dec 98 Mar 99 Jun 99 

Year 

Jun 96 

Jun 97 

Dec98 

Mar 99 

Jun 99 

Patients Waiting for Surgery 

89,620 

79,897 

68,625 

60,929 

50,422 

60,000 

Patients Waiting for First Specialist Assessment 

Total patients waiting >6 months 

The number of people waiting more 

than six months for a first specialist 

assessment has decreased, due to first 

specialist assessment management 

processes and care and review strategies 

being developed and implemented 

throughout the country. 

50,000 

40,000 

30,000 

20,000 

10,000 

0 

1st Quarter 

2nd Quarter 3rd Quarter 4th Quarter 

Year 98/99 

1st Quarter 

2nd Quarter 

3rd Quarter 

4th Quarter 

Patients Waiting for Assessment 

47,729 

45,468 

45,372 

35,774 

28

Complex Medicine: Managing the 

Issue 

Issues 

We have developed national referral protocols and 

business rules to define policy, eligibility and access 

criteria for complex (often high profile) situations 

involving special high cost treatments, exceptional 

circumstances for patients, or where patients have 

to be transferred to a different region. 

To date, a national case manager has been put in 

place to oversee these services. Systems, such as a 

database of cases and more robust approval 

procedures, are being developed. 

Special High Cost Treatments 

We fund special high cost patient treatments with 

a budget of $14.7 million, covering: 

• Medical treatment overseas. 

• Simultaneous pancreas and kidney transplants. 

• Treatment by private providers. 

• New technologies/treatments. 

• Tolerisation. 

• Hospital high cost treatment items not included 

in base contracts, for example, heart/lung 

transplants. 

• Liver treatments. 

• Complex patient transfers between regions. 

Exceptional Circumstances 

We provide for financial assistance for eligible 

persons who require pharmaceuticals, but whose 

needs cannot be met under PHARMAC’s 

Pharmaceutical Schedule. Approximately $850,000 

is allocated annually. 

Inter-regional Flows 

The budget for patient transfers between regions 

is $75 million annually. The new protocol 

developed by the HFA covers: 

• Acute and arranged admissions to a public 

hospital which is outside a patient’s region 

• Elective, acute and arranged admissions of 

persons who are referred from a hospital which 

is outside their region. 

Personal Health intends devolving patient transfers 

to hospital contracts and this is already happening. 

This area of public sector healthcare requires 

ongoing development and solutions related to: 

• Transport and accommodation approvals and 

payments associated with patient transfers. 

• Review of the process for examining exceptional 

circumstances applications. 

• Clarity around the cost utility analysis process 

with the move to evidence-based medicine 

Personal Health will conduct a review of these 

arrangements this year. 

Diabetes: Moving Forward 

Issues 

Diabetes is a Maori health priority and a priority 

for disease state management. 

There are about 120,000 people with diabetes, with 

potentially a further 40,000 - 60,000 undiagnosed. 

The rate is increasing by 3 percent annually. 

Maori and Pacific Islands people have a nearly three 

times higher prevalence, and their diabetes 

mortality rate in the 40-65 year age range is nearly 

10 times higher than for other New Zealanders. 

In some areas 50 percent of renal failure is caused 

by diabetes and last year there were 548 lower limb 

amputations in people with diabetes. This is 

unacceptably high. Admissions to hospitals with 

diabetes as the major diagnosis cost $19 million 

(1998/99) but when hospitalisation for 

complications and other healthcare services are 

included, the total health cost has been estimated 

at $200-250 million annually. 

There is regional variation in education and some 

treatment services. Nationally, only 30 percent of the 

necessary eye screening (to reduce blindness in 

people with diabetes) is being funded. Early detection 

of diabetes is important and needs careful planning. 

The core of our strategy is to introduce informationbased 

disease management techniques. 

These techniques allow providers to look across 

traditional boundaries and manage patients far 

more effectively. The strategy is moving in tandem 

with the primary care strategy in particular. 

Implementation of our diabetes strategy is well 

under way. 



• Increased diabetes funding by $5 million 

annually per year (from 1999). There is 

justification for similar increases in funding 

next year. 

• Reduction of barriers (cost, access, and cultural) 

to high quality routine care for those at highest 

risk (Maori, Pacific Islands people and low 

socio-economic groups). 

• Building strong feedback links with patient 

organisations. 

• Developing guidelines for diabetes services and 

a clinical indicators framework to monitor 

performance. The national diabetes working 

group of clinicians and consumers is already 

established. 

• Commitment to involve patients and clinicians 

in teams (regional or locality level) in 

monitoring diabetes services in their areas and 

recommending improvements. Terms of 

reference have been developed, and 

consultation is now occurring. 

• Integration of education into primary care 

treatment, with specific choices for Maori and 

Pacific Islands people (extra funding has been 

allocated). 

• Progressively increasing the funding for allied 

diabetes services in primary care (nurse 

educators, dieticians, and podiatrists) and Maori 

and Pacific Islands provider organisations 

prepared to maintain active diabetes registers 

and present their data to regional/locality 

diabetes teams. 

• Negotiations with primary care organisations 

for an annual review and individual treatment 

plan for every person with diabetes, with the 

aim to make this service free (at least) to 

Community Service Cardholders. This review 

will be used to detect complications early, and 

update the diabetes register used to monitor 

diabetes in the enrolled population. 

• A planned increase in funding for mobile 

services, eye screening 2000, and monitoring 

of increased access using information from the 

diabetes registers. 

• Development of proposals for early screening, 

targeted at high-risk groups. 

Asthma: A High Priority 

Issues 

More than 500,000 New Zealanders have asthma 

and the figure is growing inexplicably. The number 

hospitalised is increasing despite advances in 

therapy, asthma treatment plans and the good 

supply of new medications and devices. 

There is a high incidence amongst Maori and Pacific 

Islands peoples. Increasing hospital admissions are 

partially explained by Maori and Pacific Islands 

peoples’ poor access to care and the use of hospital 

emergency departments by people who should have 

seen their primary care provider earlier. 

Other contributory factors include patients’ failure 

to use drugs and devices appropriately, and lack of 

monitored care programmes. 

Asthma is the second of our disease state 

management programmes. 


• $2.7 million for a disease management strategy, 

including $400,000 to help develop Maori 

provider skills. Contracts with providers for 

provision of additional services should be 

signed next February. 

• Formation of a national asthma working group 

drawing on professionals and patient groups to 

provide advice. 

• Development of quality and service 

performance monitoring. 

• Liaison with PHARMAC about the appropriate 

use of drugs and with the Asthma and 

Respiratory Foundation for the possible funding 

of some foundation projects. 

Heart Disease: Preparing the Way 

Issues 

Coronary artery disease remains one of the major 

causes of mortality, particularly among 

males. Maori men have a particularly high 

mortality rate, which is 1.7 times higher than 

other males. Maori women have a mortality rate 

30

at nearly twice that of non-Maori and equivalent 

to New Zealand males. 

Coronary artery disease can be treated by drugs, 

angioplasty (PTCA) and/or coronary artery by-pass 

surgery (CABG), depending on the stage of the 

disease. Treatment for coronary artery disease spans 

the primary, secondary and tertiary sectors. 

There are a number of problems in the provision 

of cardiac services. A review of cardiac services 

carried out in late 1998 identified: 

• Maori had the lowest intervention rates for 

CABG yet Maori have the highest mortality rates 

from coronary artery disease. 

• Regional variations in waiting lists for PTCA 

and CABG. Canterbury Health had the largest 

waiting list for PTCA and Capital Coast Health 

had the highest waiting list for CABG. 

• Variation in the public/private intervention rates 

for both PTCA and CABG which has a regional 

impact. 

• Cardiology and cardiac surgery services are 

inefficiently purchased, mainly separately, 

which can lead to inefficiencies in the delivery 

of cardiac services. 

There is fragmentation of primary and secondary 

care, a lack of quality primary care service and a 

lack of emphasis on rehabilitation. Again, we are 

proposing an up-to-date disease state management 

approach to management of heart disease. The issue 

is identified but not actioned. It is third on the 

priority list after diabetes and asthma. 


• Establish capacity to undertake work. 

• Look at promotion of pharmaceutical 

interventions which reduce hospital admission 

and need for surgery. 

• Implement quality standards with primary care 

to ensure patients at risk are given maximum 

chance to maintain their health. 

Oral Health: Focus on Youth 

Issues 

Oral health services have become progressively out 

of kilter with changes in society. There have been 

few major changes over the last 50 years and they 

have become progressively dysfunctional. 

In particular, oral health services have failed to 

adapt to the growing needs of adolescents and 

Maori. There are long standing issues around adult 

Maori oral health and variations in outpatient and 

inpatient services provided by hospitals. 

Personal Health has seized the opportunity created 

by concern about inadequate payment of dentists 

as an opportunity to review oral health services 

from the ground up. This has been very well 

received by the sector and has revealed a strong 

public health ethos and enthusiasm for change in 

providers. We have engaged the sector through a 

joint working party (a Technical Advisory Group) 

with representatives from providers, sector 

organisations, the Maori Health Commission, and 

professional bodies. This joint working party has 

been highly effective at working through the issues 

facing oral health services. 

The Personal Health initiative has been driven by 

a need to reverse the decline in oral health. We 

also have a strong desire to link oral health back 

into the mainstream of health care. An example of 

mainstreaming is a recent initiative to contract with 

oral health Well Child providers to educate other 

Primary care providers on the importance of oral 

health. A strategy has been developed in 

conjunction with the Ministry of Health and awaits 

approval. The strategy identifies the need for 

sustainable funding for dentists and opportunities 

for dental therapists if deregulation occurs. 

The Ministry of Education wants to transfer 

purchasing responsibility for school dental clinics 

to the health vote. There are currently 

inconsistencies between the HFA and WINZ 

methods for funding low-income adult dental care, 

resulting in confusion for providers and consumers. 


• Developing more appropriate services, 

especially educational methods and 

preventative services for Maori. 

Existing successful services for Maori will be 

encouraged and duplicated. 

• Publicly consulting on options for service 

provision to encourage teenagers and children 

to access services. 


• Inviting technical advisory groups to contribute 

in assessing reporting requirements and pricing 

methods for child and adolescent services 

• Developing capitated contracting methods, 

allowing clinical freedom and encouraging 

preventative management. 

• Encouraging service integration and focusing 

on prevention and education. 

• Supporting the formation of whanau-based 

services for Maori. 

• Continuing to support the deregulation of 

dental therapists and the Oral Health Forum 

2000. 

The HFA is utilising current budgets for hospital 

dental services more effectively and working with 

the sector to identify additional information 

required. 

Immunisation: Revamp in Action 

Issues 

Immunisation coverage has improved but remains 

inadequate to prevent cyclical problems such as the 

current whooping cough epidemic. Some children 

(particularly Maori and Pacific Island) do not have 

regular GPs so miss out on immunisation. 

Most GPs achieve high coverage rates for their 

regular child patients. The NHC report reiterated 

many of the known problems. The HFA has 

programmes in place or under development to 

address the major recommendations. The agreed 

overall target is 95 percent. 

The additional cost of achieving targets is probably 

$10-$15 million annually (excluding catch-up 

programmes). Personal Health is unlikely to 

achieve Funding Agreement targets without 

additional resources. 


Immunisation strategies in place or being 

developed include: 

• A comprehensive upgrade of the programme 

such as opportunistic out-reach immunisation, 

and targeting of areas of poor immunisation 

rates, such as South Auckland. 

• Primary care initiatives in Rotorua, Union 

Health Services and elsewhere have more than 

90 percent coverage. The new primary care and 

section 51 initiatives will encourage others to 

achieve these results. 

• Immunisation promotion through HHS public 

health, Well Child, and Maori and Pacific Island 

health services. Immunisation co-ordination 

will be expanded in 2000. Maori health 

initiatives have achieved high coverage, but do 

not reach all Maori children. 

• Development of the Child Health Information 

Strategy (e.g. KidZNet in Waikato-Bay of 

Plenty). Electronic reporting will improve 

information from 2000 and assist programmes 

for low coverage areas. 

Hepatitis B: Screening Introduced 

Issues 

Hepatitis B is a highly infectious virus, spread by 

the exchange of body fluids and blood. 

Acute infection is unnoticed for 90 percent of 

patients, while 10 percent develop jaundice. 

Some 10 percent of patients develop chronic 

infection potentially resulting in liver problems: 

cancer and permanent liver damage. 

Some 90 percent of infants born to a Hepatitis B 

positive mother will become chronic carriers. 

Some 0.5 percent - 5 percent of people infected in 

adult life will become carriers. Although the 

majority of carriers may not suffer adverse 

consequences, up to 40 percent may develop 

cirrhosis or hepatocellular carcinoma. 

The regional distribution of infection is highly 

variable, predominantly in the North Island. 

There are marked ethnic differentials, with the 

Maori carrier rate 10 times higher than Europeans. 

The Pacific Islands carrier rate is eight times higher 

than the European rate and the Asian carrier rate 

is similarly high. 

Safe and effective vaccines have been available for 

at least a decade but the initial price and lack of 

awareness about Hepatitis B has limited their use. 

However, there is a new gull programme of 

immunisation. Vaccination is the mainstay 

internationally, but New Zealand is also 

implementing a screening programme. 


• Approximately $32 million over three years to 

fund a Hepatitis B screening programme for 

32

high risk populations in a limited geographic 

area; $22 million for screening and surveillance; 

$10 million for secondary/tertiary care. 

• Introduced contracts with providers to focus 

on 70 percent uptake by the target population 

in the North Island over three years: Maori, 

Pacific Island and Asian people over 15 years 

(an estimated 495,000 people). 

• Introduced formal evaluation of the programme 

over three years, comparing the two models of 

service delivery: Lower North (Hepatitis 

Foundation) is community-based, Upper North 

(A+ Consortium) is provider-based. 

• Development of an independent steering 

committee to oversee the Hepatitis B 

programme. 

Sexual and Reproductive 

Services: Under the Microscope 

Issues 

Sexually transmitted diseases are spreading, 

particularly among young people and there is a very 

high incidence of chlamydia. 

A number of issues have arisen, including 

availability of specialist services, interaction 

between specialist and primary services, funding, 

workforce availability and development, and 

resources for health promotion. 

We are particularly pleased with the new sexual 

health service in Wellington. We may look to 

extend the ideas from this service through the 

country, although a full evaluation will need to be 

completed. 


• We have undertaken a stock take of sexual 

health service funding and the assessment of 

sexual health services is a priority for 2000. 

• Increased funding for contraception was made 

available in 1996/97 and this has been 

continued. 

Oncology: Reviewing Drugs and 

Radiation 

Oncology is an area of rapid growth and 

opportunity to improve care. An ageing population 

and new technology mean greater demand for 

resources. The challenge is to make sure resources 

are available to the areas of greatest benefit. 

As with cardiology, there is potential for reducing 

illness by suitable prevention activities such as 

reducing smoking. 

Issues 

• Capital expenditure on equipment. 

• Staffing recruitment and retention in radiation 

and oncology. 

• Increasing incidence of cancer. 

• The method of assessing new drugs and their 

funding. 


• Following a waiting time problem in 

MidCentral Health in May 1999, a working 

party was set up with MoH to identify issues 

and find solutions. The working party 

comprised radiation oncologists, medical 

radiation technologists and medical physicists. 

Personal Health identified the costs of providing 

radiation oncology, developing methods that 

can be used in other sectors. 

• This resulted in an effective working 

relationship between all participants (including 

the working party, HFA, MoH, CCMAU and 

hospitals). This will assist in the progress of 

future service review work. The work 

completed so far has increased clarity of current 

costs and sustainable prices, which links with 

broader service strategy work on sustainable 

pricing and capital investment policy. 

• A medical oncology group, similar to the 

radiation oncology group, has been recently 

formed. This group will work with the HFA and 

MoH to address some of the issues of assessment 

of new treatments. 

• Pilot programmes for sexual and reproductive 

health promotion for Pacific Island people were 

established in 1997/98 and have now been 

evaluated. 


Palliative Care: Studied for the 

First Time 

Hospices have been largely funded privately since 

they were established in the 1970s. In recent years 

some funding has come from Government as 

hospices increasingly compete with charities for 

funds. At the same time, the number of hospital 

and GP referrals to hospices is rising. Hospice New 

Zealand believes hospices should be recognised as 

a core health area and funded accordingly. 

Issues 

• Inconsistent access and quality of hospice 

services nationally. 

• Only a small proportion of eligible people 

receive the complete service. 

• Service co-ordination issues between providers, 

including fragmentation and duplication. 

• Regional differences in funding. 


We undertook interim work this year, before a 

national strategy is developed, to assist the most 

poorly-funded hospices unlikely to survive financially. 

The palliative care strategy is being undertaken 

jointly by the HFA, MoH, and NHC. It builds on 

the interim (and incomplete) work started by the 

NHC two years ago. The team is working with an 

advisory group comprising experts and a consumer 

representative. A reference group of interested 

organisations has also been formed which will 

advise on issues such as child palliative care and 

first level consultation. 

The following work has been, or is close to being, 

completed: 

• Definition, principles and a model of 

palliative care. 

• Stocktaking of contracts of all palliative 

care providers. 

• Analysis of questionnaires sent to hospices on 

the provision and costs of care. 

• Analysis for determining the need for 

palliative care. 

Cervical Screening Investigation: 

Gisborne 

Issues 

In March 1999 the HFA became aware of the 

performance of Gisborne pathologist Dr Michael 

Bottrill, who retired in 1996. An expert advisory 

group was established in May which confirmed the 

investigation should focus on the initial concern - 

Dr Bottrill’s reading of cervical smear slides. 

Personal Health’s action 

Twenty-three thousand cervical smear slides (all 

from Dr Bottrill’s laboratory between 1991 - 1996) 

were re-read last year by a Sydney laboratory. The 

investigation affected just over 12,000 women who 

had smears read by Dr Bottrill’s laboratory during 

this period. In March 2000, following the 

completion of the re-reading, and subsequent result 

matching, all affected women were sent a letter 

detailing their individual slide results. 

During its investigation, the HFA introduced an 

additional range of measures to support these 

women (both those living in Gisborne and those 

now living elsewhere). These measures include: 

• Free smears, GP consultations and counselling 

services. 

• Establishment of an 0800 number. 

• Facilitation services encouraging women to 

access smears. 

• Co-ordination services to assist women to 

access all public sector entitlements. 

• Experienced colposcopy services with 

minimum delay for women identified with 

previously unreported high-grade 

abnormalities. 

• Special circumstances support, under which the 

HFA meets childcare, travel and home support 

costs to enable women access to diagnosis and 

treatment services. 

The total cost of the investigation (including the 

re-reading and support services) is estimated at $1.5 

million. This was budgeted for in the 1998/99 

financial year and carried forward into the 

current one. 

34

Throughout the process, the HFA has contacted 

women with high-grade abnormalities so that they 

can immediately commence treatment. The HFA 

sought advice on whether women with previously 

unreported low-grade abnormalities should be 

contacted during the re-reading. It was advised that 

informing these women at the end of the process 

did not pose any risk to their health. The HFA made 

the necessary services available to deal with these 

quickly when result letters were sent out. 

Interim results from the first 5,000 slides indicated 

substantial under-reporting by Dr Bottrill. This 

pattern continued throughout the entire re-reading. 

They indicated an extremely high error rate even 

allowing for potentially increased sensitivity by the 

re-reading laboratory. The interim results were 

announced publicly because the investigation has 

been extended to other work undertaken by Dr 

Bottrill. 

On the advice of the advisory group, the 

investigation was initially extended to a re-reading 

of breast histology specimens. Breast histology is 

an area with potential to improve health outcomes 

if mis-reading is found and was considered likely 

to give the quickest indication whether there is a 

pattern of mis-reading of histology by Dr Bottrill. 

The HFA arranged for 380 breast histology cases 

originally read by Dr Bottrill’s laboratory between 

1989 and 1996 to be re-read. A number of 

differences were found and reviewed by an expert 

breast surgeon, who determined that these 

differences were of clinical significance in only two 

cases. 

Paediatric Specialty Services: 

Review Underway 

This is a joint project between Personal Health, 

Paediatric Society of New Zealand and MoH. 

It ensures nationally consistent access and quality 

standards. 

• Agreement has been reached for a national 

paediatric oncology service. Hospitals are now 

putting forward plans to meet the agreed quality 

guidelines. 

• Guidelines for Attention Deficit Hyperactivity 

Disorder and Downs Syndrome, a national 

tumour board and Child Health Network are 

being developed. 

• Joint working groups of GPs, nurses, Maori and 

Pacific Islands health providers and HFA staff 

are looking at pricing of primary care services, 

definitions of the services purchased, future 

roles of primary care organisations and 

information requirements and enrolment. 

We are analysing the recommendations and cost 

for all other paediatric subspecialties. 

A significant, linked issue is travel and 

accommodation policy. Paediatric specialties will 

continue to be centralised as quality standards are 

implemented. This means more travel for patients 

and their guardians. A review of travel and 

accommodation is underway. 

It is important to note there is a small margin of 

error associated with all pathology and histology 

work. It should also be noted that advances in the 

diagnosis of breast cancer have helped to reduce 

the small chance of these errors occurring. 

After careful consideration of all available 

information, the Advisory Group has concluded 

that the breast histology work by Dr Bottrill’s 

laboratory is of the standard expected. 

The Advisory Group has therefore recommended 

that the investigation is not extended into any other 

areas, and the HFA has accepted this 

recommendation. 


Personal Health — 

Financial Information At A Glance 

Personal Health Services Budget 

Personal Health has been responsible for 

managing $3,745.9 billion (67 percent) of the 

Health and Disability Fund ($5.748 billion) for 

public health services provided by the Government 

from taxpayer funds. 

The following table (sourced from the General 

Ledger) provides an overview of the services 

purchased: 

Break-Out of the Hospital 

Spending 

Of the Health and Hospital Services (HHSs), 

Auckland Healthcare, (an aggregate of Auckland 

Hospital, Starship, National Women’s and 

Greenlane), has by far the largest amount of public 

money spent on medical surgical services, 

at $348 million. 

Personal Health Services Purchased in 1999/00 

Service Grouping 

Value $million 

Community Services 

Child and Youth 73.9 

Maternity and Neo-natal 353.4 

Oral Health 89.2 

Pacific People’s Health 5.2 

General Practice Services 367.4 

Population Based Services 42.6 

Pharmaceuticals 645.2 

Laboratories 172.5 

Other Referred Services 47.3 

Sub-total 1,806.7 

Medical Surgical Services 

*Medical surgical 1,968.5 

Special High Cost Treatments 

and Exceptional Circumstances 14.8 

Inter Regional Transfers 55.9 

Sub-total 2,039.2 

Total 3,745.9 

Services purchased. 

* Including non-HHS based contracts. 

Medical/Surgical Services 

expenditure by HHS 


Auckland Healthcare 348 

Waitemata Health 87 

South Auckland Health 172 

Northland Health 62.5 

Health Waikato 185.7 

Pacific Health 81.6 

Lakeland Health 38.7 

Tairawhiti Healthcare 23.7 

Taranaki Health 47.9 

Good Health Wanganui 29.1 

Healthcare Hawkes Bay 64.9 

Midcentral Health 79.8 

Capital Coast Health 154.9 

Hutt Valley Health 49.2 

Wairarapa Health 16.8 

Nelson Marlborough Health 45.1 

Health South Canterbury 23 

Coast Health Care 16.5 

Canterbury Health 234.2 

Healthlink South 2.8 

Healthcare Otago 96.1 

Southern Health 37.4 

Total 1,898.2 

Hospital and Health Services spending by 1999/2000 

Contract Value, including Waiting Time Fund. 

36

Clinical Groupings 

Our systems also provide a breakdown of service 

spending by clinical groupings as set out in the table 

below. 

Types of Admittances 

The table below sets out the category of hospital 

admittances. 

Service 


Admittance Type 


Cardiology 63.2 

Cardiothoracic 58.2 

Dermatology 5.0 

Ear, Nose and Throat 42.4 

Emergency Department 101.6 

Endocrinology and Diabetic 13.6 

Facility level - Personal Health 48.5 

Acute 824.7 

Elective 350.7 

First Specialist 70.4 

Follow up 111.0 

Outpatient Community 541.4 

Total 1,898.2 

1999/2000 Contract Value by Admittance Type 

Gastroenterology 19.9 

General Internal Medical Services 299.9 

General Surgery 220.6 

Gynaecology 76.8 

Haematology 38.2 

Infectious Diseases (Venereology) 4.0 

Medical Genetics Services 2.0 

Medical Surgical - Other 24.3 

Neurology 17.5 

Neurosurgery 23.8 

Oncology 83.9 

Ophthalmology 40.7 

Orthopaedics 214.8 

Paediatric Medical 75.8 

Paediatric Medicine 10.7 

1999/2000 Paediatric Contract Surgical Value by Service Type 27.8 

Palliative Care 2.8 

Plastic and Burns 37.7 

Renal Medicine 61.0 

Respiratory 31.5 

Rheumatology 7.8 

Spinal Services 3.8 

Urology 34.6 

Vascular Surgery 19.7 

Other 185.8 

Total 1,898.2 


Indicative Prices and Patient Numbers 

Most funding for personal health services is spent outside of hospitals (55 percent) and paid to private 

primary care providers such as GPs and Maori providers. We contract hospitals to provide medical and 

surgical services, maternity services and some specific community services. 

Here we provide indicative prices for the “Top 100” sample of elective surgery, ranked in desending order 

according to expenditure values. 

Top 100 Indicative prices paid by the HFA for inpatient hospital 

procedures, ranked by total expenditure 

Rank 

Diagnostic Related Group (DRG) Description 

National 

Price 

1999/00 

per patient 

Number of 

Discharges 

Total 

Expenditure 

$million 

1 Tracheostomy except for mouth, larynx or pharynx disorder age >15, 

including intensive care and continuous mechnical ventilation $41,027 880 36.1 

2 Circulatory disorders with AMI without invasive cardiac investigative 

procedure without major complications $ 3,839 5097 19.6 

3 Hip replacement without complications $ 8,877 2179 19.3 

4 Major small and large bowel procedures with complications $11,516 1654 19.0 

5 Trans-vascular percutaneous cardiac intervention $ 7,198 2471 17.8 

6 Cerebrovascular disorders except TIA with complications $ 5,758 3076 17.7 

7 Respiratory infections or inflammations age >54 with complications $ 4,079 4200 17.1 

8 Heart failure and shock $ 2,639 6059 16.0 

9 Chronic obstructive airways disease $ 1,919 7368 14.1 

10 Coronary bypass without invasive cardiac investigative procedure 

without major complications $15,355 801 12.3 

11 Hip replacement with complications $10,796 1129 12.2 

12 Hip and femur procedures except major joint with complications $ 9,597 1178 11.3 

13 Lens procedures without vitrectomy and without complications $ 2,159 4909 10.6 

14 Unstable angina with complications $ 2,639 3531 9.3 

15 Major small and large bowel procedures without complications $ 7,438 1252 9.3 

16 Cardiac pacemaker implantation $12,476 718 9.0 

17 Lower extremity and humerus procedures except hip, foot, 

femur age

29 Craniotomy with complications $15,115 495 7.5 

30 Bronchitis and asthma age 64 

or with non-major complications $ 21,353 263 5.6 

39 Kidney, ureter and major bladder procedure for non-neoplasm $ 5,518 1017 5.6 

40 Infections and inflammations of bone and joint with miscellaneous 

muscular system and connective tissue procedures $ 6,958 802 5.6 

41 Tracheostomy for multiple significant trauma age >15 $48,944 112 5.5 

42 Neonate, admission weight 750-999g $38,867 140 5.4 

43 Respiratory neoplasms with complications $ 3,359 1617 5.4 

44 Extensive OR procedure unrelated to principal diagnosis $ 5,758 939 5.4 

45 Septicaemia age >34 $ 5,038 1071 5.4 

46 Abdominal pain or mesenteric adenitis without complications $ 720 7379 5.3 

47 Craniotomy without complications $ 8,877 578 5.1 

48 Dental extractions and restorations $ 960 5267 5.1 

49 Dementia and global disturbances of cerebral function $ 5,038 1002 5.0 

50 Neonate, admission weight >2499g, without significant OR procedure, 

without problem $ 720 6771 4.9 

51 Circulatory disorder without AMI with invasive cardiac investigative 

procedure without complicating diagnosis and without major 

complications $ 1,440 3227 4.6 

52 Cellulitis (age >59 without complications) or (age 74 or (age 10-74 with complications) $ 1,440 3117 4.5 

55 Circulatory disorder without AMI with invasive cardiac investigative 

procedure with complicating diagnosis or with major complications $ 2,399 1864 4.5 

56 Neonate, admission weight >2499g, without significant OR procedure, 

with major problem $ 2,639 1643 4.3 

57 Hand or wrist procedures except major joint $ 1,200 3609 4.3 

58 Other OR procedure for multiple significant trauma $18,954 220 4.2 

59 Major reconstructive vascular procedure without pump with major 

complications $14,635 284 4.2 

60 Soft tissue procedures $ 2,159 1922 4.2 

61 Kidney and urinary tract infections age

67 Endoscopic procedures on female reproductive system $ 960 3970 3.8 

68 Neonate, admission weight 1250-1499g, without significant OR 

procedure $16,075 234 3.8 

69 Major procedures for malignant breast conditions $ 4,559 824 3.8 

70 Gastroenteritis age 64 $ 4,319 761 3.3 

84 Peripheral vascular disorder (with non-major complications) or 

(age >74 without complications) $ 1,919 1700 3.3 

85 Coronary bypass without invasive cardiac investigative procedure with 

major complications $18,714 174 3.3 

86 Renal failure with complications $ 4,079 793 3.2 

87 Appendectomy with complicated principal diagnosis $ 3,599 898 3.2 

88 Cardiac valve procedure with pump without invasive card investigative 

procedure with major complications $24,712 129 3.2 

89 Minor head injury $ 720 4374 3.1 

90 Other respiratory system diagnoses age >64 with complications $ 3,119 1006 3.1 

91 Cardiothoracic or vascular procedures for neonates $54,702 57 3.1 

92 Vascular procedures except major reconstruction without pump without 


93 Vascular procedures except major reconstruction without pump with 


94 Stomach, oesophageal and duodenal procedures with non-major 

complications $10,557 291 3.1 

95 Cystic fibrosis $ 6,958 439 3.1 

96 Neonate, admission weight 1000-1249g, without significant 

OR procedure $16,075 184 3.0 

97 Shoulder, elbow or forearm procedures except major joint age

Top 100 Indicative prices paid by the HFA for inpatient hospital 

procedures ranked by discharge number 

Rank 

Diagnostic Related Group (DRG) Description 

National 

Price 

1999/00 

per patient 

Number of 

Discharges 

Total 

Expenditure 

$million 

1 Abdominal pain or mesenteric adenitis without complications $ 720 7379 5.3 

2 Chronic obstructive airways disease $ 1,919 7368 14.1 

3 Bronchitis and asthma age 2499g, without significant OR procedure, 

without problem $ 720 6771 4.9 

5 Other skin, subcutaneous tissue and breast procedures $ 960 6255 6.0 

6 Heart failure and shock $ 2,639 6059 16.0 

7 Chest pain $ 960 5953 5.7 

8 Tonsillectomy and/or adenoidectomy $ 960 5938 5.7 

9 Dental extractions and restorations $ 960 5267 5.1 

10 Cellulitis age

38 Lower extremity and humerus procedures except hip, foot, femur 

age

77 Abortion without D and C $ 720 1620 1.2 

78 Respiratory neoplasms with complications $ 3,359 1617 5.4 

79 Signs and symptoms of musculoskeletal system and connective tissue 

age

Relationships With Communities 

Maintaining positive, sustainable and mutually beneficial relationships with health providers, health 

professionals, the many organisations representing them, in fact, the tens of thousands of people working in 

health and community services sector 1 , requires ongoing commitment and communication on the part of 

Personal Health staff. 

Transparent decision-making and using clear sets of principles to determine what services are funded is the 

approach the Personal Health has adopted. 

But initiating continuing dialogue and consulting with the communities of professionals is a vital key to 

achieving the desired health gains for New Zealanders. Five HFA community relations managers work in 

the various localities to facilitate community dialogue and consultation. 

However, Personal Health managers play a major role in sector communication and collaboration. 

Expert advisors and technical committees add knowledge and depth to Personal Health’s base of expertise 

while also keeping communication channels open. 

Personal Health Senior 

Management Team 

David Moore 

General Manager 

David has a Master of 

Commerce and a Diploma of 

Health Economics, and has 

had a wide range of 

experience in both public 

and private sector 

organisations, including the 

Department of Health and 

Treasury. He was the General Manager of 

PHARMAC from 1993 to 1998, when he left to 

become the General Manager of Personal Health 

group. He was also regional director of the 

Transitional Health Authority during the 

amalgamation of the RHAs into the HFA. 

David was acting joint chief executive officer of 

the HFA with Kath Fox from Phil Pryke’s 

resignation until the appointment of Sally 

Wilkinson as interim chief executive officer. 

Mara Andrews 

Service Strategy Manager 

Mara has a Business Studies 

qualification endorsed in 

health management from 

Massey University, and has 

nearly completed an MBA 

from Henley Management 

College in the UK. She recently 

returned from a three month study visit to the USA 

and Canada on a World Health Organisation 

Fellowship, where she looked at health services for 

indigenous people. 

Mara is of Ngati Kahungunu, Whakatohea, and 

Ngati Raukawa descent, and came to Personal 

Health from the HFA’s Maori Health group, where 

she had worked as a manager for more than five 

years. In that time, she was also project manager 

for the Napier-Hastings needs assessment. 

John Baird 

Senior Project Manager 

John has a background of 15 

years in the health sector. 

His initial interests were in 

medical research, completing 

a BMedSci before working for 

a pharmaceutical company. 

He also has an MBA with 

an interest in service 

management and health sector information. 

In 1995, John joined Coopers and Lybrand 

as a health sector consultant. Notable projects 

included hospital business planning and site 

configuration, a variety of hospital and primary 

care service development initiatives, and 

purchasing development work for regional 

health authorities. 

John joined the THA in 1997 to work in the primary 

care area, before being appointed to his current role 

in August 1998. 

44

Win Bennett 


Win has a background of 

twenty years in general 

practice. He has an MBChB 

and a BMedSci from Otago 

University. Win became 

interested in health policy 

and has almost completed an 

MPP from Victoria University. 

He was medical director of PHARMAC for five 

years, and briefly general manager, before 

transferring to the HFA. 

Win is at present focusing on primary care and 

service development. He has a particular interest 

in evidence-based purchasing, disease state 

management and getting the sector to work 

together for the benefit of patients. 

Chris Chadwick 

Planning Manager 

Chris has an MSc (1 st Class 

Hons) in mathematics from 

Auckland University, as well 

as a Diploma in Health 

Administration from Massey 

University. He has formal 

training in work study and 

method study in the health 

sector, and spent four years in service management 

in London Teaching Hospitals. 

His career in health management in New Zealand 

has included positions with the Auckland Hospital 

Board, Auckland Area Health Board, and North 

Health (the regional health authority for the 

northern region). He has considerable experience 

developing and monitoring Funding Agreements, 

and is currently responsible for planning and 

business processes within Personal Health. 

Peter Daws 

Senior Locality Manager, Christchurch 

Peter has an MBA, and 

various other qualifications in 

management and health 

services management. He has 

worked in health management 

for about 15 years, mostly in 

the National Health Service in 

Britain. 

His previous experience has included senior 

hospital administration positions at two London 

hospitals. At the start of the purchaser/provider 

reforms in 1991, he moved to the Harrogate Health 

Centre in north Yorkshire, where he worked until 

1998. In 1998, he moved to New Zealand and 

joined the HFA. 

Martin Hefford 

Senior Locality Manager, Wellington 

Martin has a BA and 

Postgraduate Diploma in 

psychology and an MA 

(Applied) in social work. 

He worked as an advisory 

officer at the Department of 

Social Welfare from 1986 

until 1991, when he became 

coordinator of the Wellington branch of the 

Schizophrenia Fellowship. In this position, he 

managed a community activity centre, and respite 

care, education and support services for people with 

serious mental illness and their families. 

He joined the newly established Central RHA in 

1993 as a disability support services analyst, 

and managed the deinstitutionalisation of Porirua 

Hospital. In 1995, Martin was appointed to manage 

the new Mental Health group when the RHA 

restructured, and became the Personal Health 

senior locality manager in 1998. 

Julian Inch 


Julian has qualifications 

in economics, systems 

modelling and management 

to postgraduate level. He has 

worked in the Ministry of 

Health as a senior economist 

and manager in the health 

policy and funding area, 

as well as both Wellington Hospital and 

Canterbury Health. 

He joined the HFA in 1998, and has a strong interest 

in improving its purchasing functions. He and his 

team have focused on putting national purchase 

frameworks and developing prioritisation, 

contracting and monitoring tools and processes. 

Julian has built close relationships with key sector 

groups and stakeholders, and the service strategy 

team has a good reputation in the sector. 


Sue Keppel 

Senior Locality Manager, Auckland 

Sue has an LLB (Hons) and 

an MJur (Distinction) and 

is a registered general 

and obstetric nurse. 

She has had considerable 

experience in the health 

sector, both funding health 

services and working for a 

variety of providers. 

In her current position as senior locality manager, 

Sue is responsible for Personal Health contracts in 

the Auckland and Northland areas. 

David Pearson 

Finance Manager 

David has an MBA and a 

BCom in accounting, and is 

a member of the Institute of 

Chartered Accountants of 

New Zealand. Prior to 

joining the HFA in 1998, 

he was the Director of 

Finance for the New Zealand 

Customs Service, where he was responsible for 

corporate finance services. 

He has also been an associate partner with BDO 

Hogg Young Cathie, a chartered accountancy firm, 

a contractor in finance roles in England, and an 

auditor with Coopers and Lybrand. 

Grant Ramsay 

IM Manager 

Grant has worked in 

information systems for the 

HFA and its predecessors 

since 1994. He has a BCom 

from Canterbury University 

and is completing a Graduate 

Diploma of Business 

in information systems 

at Auckland University. 

In his information systems roles, Grant has 

implemented contract management, client 

enrolment and payment processing systems, lead 

the integration of North Health operations into 

national HFA and HBL operations, and managed a 

development group of 40 during the transition from 

RHAs to the HFA. His current role focuses on key 

strategic information management and business 

process developments, including those of HBL. 

Ross Smith 

Senior Locality Manager, Hamilton 

Ross has a BCom from 

Canterbury University, and 

has had extensive experience 

in senior commercial roles in 

the manufacturing sector. 

He joined Midland RHA as 

a contract relationship 

manager in 1993. In 1998, 

he was appointed as senior 

locality manager for the Personal Health group. 

Since 1993, he has been involved in major provider 

contract negotiations, often involving significant 

change management and community consultation. 

He has extensive networks with the local 

communities and providers served by the Hamilton 

office, and wide experience in developing local 

solutions to improve health service delivery. 

Other senior managers 

Gillian Bohm 

Quality Auditor 

Gillian is responsible for 

audit and quality 

improvement programmes in 

hospitals and health services. 

She has welcomed the 

opportunity to articulate 

quality imperatives for public 

hospitals and to initiate 

projects that address national deficits in the 

provision of safe care. 

She was involved in a project to review systems for 

checking the credentials of medical practitioners 

that is accepted by the sector and will be used in 

the development of a national framework and 

process to be extended to other professional groups. 

Gillian was also involved in auditing HHS systems 

for reporting incidents. This audit provided the 

information for a guideline for reportable events 

in HHSs. 

46

Barbara Browne 

Maternity Advisor 

Barbara is a registered nurse 

and has a BA and an LLB 

(Hon). She is responsible for 

leading the maternity 

services review, developing 

the HFA’s future maternity 

strategy, and maintaining 

present maternity contracts. 

She works with consumer, provider, and 

professional groups to deliver high quality and 

coordinated services. Her role is split between the 

service strategy team and the Auckland and 

Hamilton locality teams. 

She has previously worked as a nurse and 

operational manager in hospitals, an educator for 

a postgraduate nursing and midwifery course, 

a health sector union organiser, and a locality 

manager for the Midland RHA. 

Gabrielle Collison 

Clinical Advisor 

Gabrielle has an MBChB, 

DPH, and DIH, and is a 

Fellow of the Australasian 

Faculty of Public Health 

Medicine. She is the 

northern regional director of 

training for the AFPHM, and 

has a long history of working 

in public health medicine in New Zealand. 

In her current role, she is the leader of the child 

health project and chair of the paediatric specialty 

services review group. She has been involved in 

the development of the child health business plan 

to implement the child health strategy, grouping 

all HFA child health workstreams to improve 

linkages, and addressing service delivery, 

configuration and workforce issues such as in 

paediatric oncology services. 

Sandy Dawson 

Chief Clinical Advisor 

Sandy is a doctor with postgraduate qualifications 

in occupational medicine and aviation medicine, 

and is a Fellow of the Australasian Faculty of Public 

Health Medicine. He has worked for the RNZAF 

and Air New Zealand, 

looking at how people 

perform in stressful 

environments. He then 

worked at ACC as their 

corporate medical advisor. 

He is part of the team 

working on developing disease-state approaches, 

especially in diabetes, and provides clinical input 

for high-cost treatment and prioritisation processes. 

Sandy promotes having more clinician and 

consumer input to maximise the focus on getting 

the best value from the funding available. 

Martin de Boer 

Team Leader, Service Information 

Martin has a BSc in 

operations research and a 

Diploma of Public Health. 

His previous work experience 

has included independent 

contracting work for the 

HFA, consultant at KPMG, 

and statistician for the 

Analysis and Monitoring Unit of the Public Health 

Commission. 

In his current role, Martin’s key responsibilities 

include monitoring and leading the service 

information team. His most recent projects have 

been on HHS purchasing and the national 

minimum dataset. 

Laura Lambie 


Laura is a registered nurse 

and midwife, with additional 

qualifications in education 

and public health. Before she 

joined the HFA, she has 

worked on major reviews at 

Capital Coast Health, 

maternity research through 

Otago University, education of health professionals, 

and work in management and as a health 

professional. 

In her current role, Laura is responsible for 

developing a national strategy for funding palliative 

care. The palliative care project will eventually 


esult in nationally consistent palliative care 

services being available for all New Zealanders. 

She is also responsible for developing a strategy 

for purchasing cardiac services within a disease 

management approach. 

Julie Martin 

Project Manager 

Julie is a registered general 

and obstetric nurse, and has 

a Diploma in Business 

Studies and an Advanced 

Diploma in Nursing. She is 

currently completing a 

Masters of Health 

Management through Massey 

University. Her key area of interest is in improving 

health sector management, especially in primary 

and community care. 

Prior to joining the HFA, Julie worked for the 

Auckland Methodist Mission Aged Care Services, 

where she established their in-service training 

department and implemented organisation-wide 

quality management programmes. She is currently 

responsible for the Hepatitis B, integrated care, rural 

health and diabetes projects. 

Tracy Mellor 

Team Leader, Quality and Audit 

Tracy has a BA in 

developmental psychology, 

and is a Fellow of the 

Chartered Institute of 

Housing. Before joining the 

Central RHA, she had 

extensive experience in 

public sector housing 

management in England, and developed particular 

expertise in the development and monitoring of 

contracts. 

In her first position at the RHA, Tracy was 

responsible for child and adolescent health services. 

Following the amalgamation of the RHAs into the 

HFA, Tracy was appointed team leader of the quality 

and audit team. She has been responsible for the 

management and co-ordination of the HFA’s 

investigation into the allegations of cervical smear 

misreading in Gisborne. 

Valerie Meyer 


Valerie is a registered 

comprehensive nurse, and 

has extensive experience in 

both clinical and 

management roles within the 

health sector in New Zealand 

and overseas. Her most 

recent position before joining 

the HFA was with ACC, where she developed a 

sound base of experience in case management, 

project management, change management, and 

other areas. 

Valerie is the team leader of the waiting times 

project, and as such has been involved in the 

development and implementation of booking 

systems for elective procedures. 

Marama Parore-Katene 


Marama is a registered nurse, 

with experience working 

with Te Kohanga Reo, Maori 

Women’s Welfare League, the 

Public Health Commission 

and Plunket. At the Public 

Health Commission, she was 

the national immunisation 

and glue ear educator, with responsibility for 

developing health education resources. She was 

the Maori area manager and national Maori clinical 

educator for Plunket, and developed Plunket’s 

Kaiawhina course and standards of practice. 

Marama joined the Central RHA as a programme 

and relationship manager, responsible for IPA and 

Maori provider contract management. She then 

moved to the Maori Health group, before joining 

the Personal Health service strategy team. She is 

of Ngati Whatua, Ngati Kahu, and Ngati Wai 

descent. 

Sue Peacock 


Sue has a Masters in Clinical Pharmacy with Credit 

from Otago University. She is a Fellow of the 

Society of Hospital Pharmacists of Australia, and a 

48

member of the 

Pharmaceutical Society of 

New Zealand. She has been 

chief executive of the 

Pharmacy Guild of 

New Zealand. 

Before joining the HFA, Sue 

worked as an independent contractor, working on 

a variety of primary care projects for the 

Transitional Health Authority and RHAs. 

She is currently team leader of the primary care 

project, and has successfully managed the 

development and implementation of new primary 

care contracts under a national framework. 

Philip Pigou 


Philip has an LLB from 

Canterbury University and a 

Diploma of Business Studies 

from Massey University. 

He is also a qualified tenancy 

mediator, and was admitted 

to the High Court as a 

barrister and solicitor in 

1983. He has worked for a variety of government 

departments, including the Department for Courts 

and Housing New Zealand. 

Philip manages the laboratory services project, 

developing purchasing strategies for community 

laboratory services. He also managed the project 

to transfer post-mortem funding and purchasing 

to the Department for Courts. He has been involved 

in negotiating the national primary care contract 

and the Healthline contract. 

Ruth Rhodes 


Ruth is a registered nurse, 

with postgraduate diplomas 

in public health, nursing, and 

social work. She has 

previously worked in health 

promotion and public health 

nursing at Health Waikato. 

In Ruth’s current position, 

she is responsible for the national Tamariki Ora/ 

Well Child project and implementation of new 

funding for child health services. She is involved 

in relationship management and contract 

negotiation with numerous health providers, 

including Plunket, and also oversees dental and 

rural health services for the Hamilton locality team. 

David Sinclair 


David is a doctor, with 

specialist qualifications in 

public health. He recently 

joined Personal Health 

from the HFA’s Public 

Health group, where he 

was a portfolio manager, 

with responsibility for 

immunisation. Prior to that, he was medical officer 

of health for Health Waikato. 

In his current position as clinical advisor, David is 

responsible for developing national strategies in 

immunisation and sexual health services. Moves 

to improve immunisation have been gaining 

momentum through the HFA’s child health business 

plan, and David will help to carry this through into 

developing programmes and services. He also 

provides clinical advice on a number of other areas. 

Ruth Stannard 

Team Leader, Advanced Contracting 

Ruth has a BBS in economics, 

and has had five years’ 

experience in the health 

sector. Before joining 

the HFA, she worked at 

the Ministry of Health 

as an economic advisor, 

responsible for providing 

advice to the Government on sector structures, 

risk management, and budget initiatives. 

Her current role focuses on pharmacy and oral 

health services. She led the team that developed 

the HFA’s purchase plan and consultation document 

for child and adolescent oral health services, and 

is currently consulting with the pharmacy sector 

on access to new contracts. 

1 Some 109,320 people are employed in the health and community 

services industry sector, Statistics Department, 1998. 


Personal Health - External Advisory 

Groups and Committees 

Personal Health seeks advice and guidance from a 

wide range of stakeholder groups and the 

community. The following is a list of people 

providing advice to Personal Health or taking part 

in joint working parties with Personal health. 

HFA participants on joint working parties are not 

included. 

Travel and Accommodation Assistance Policy 

HHS Advisory Group 

Ian Anderson, Streamliners / Canterbury 

Tracey Adamson, HealthCare Hawkes Bay 

Paul Greertson, Good Health Wanganui 

Maree Neville, Capital Coast Health 

Kerry Farmer, Pacific Health 

John Phibbs, Auckland Healthcare 

John Mitchell, Health Link South 

Harry Barber, Tairawhiti Healthcare 

Fiona Robertson, Canterbury Health 

Wider Sector Advisory Group 

Helen Sullivan, National Cancer Society 

Margaret Hood, National Heart Foundation 

Jacqui Te Kani, Maori Women’s Welfare League 

Ruth Nepia / Rahira Walsh, Maori Health 

Commission 

Heather Simspon, Schizophrenia Fellowship NZ Inc 

Margaret Hamilton, Mental Health Consumer 

Consultant 

Elizabeth Cooper, Assembly of People with 

Disabilities 

Richard Buchanan, NZCCS 

Taima Campbell, Clinical Manager - Te Waka Hauora 

Sandra Murphy, Starship Children’s Hospital 

Keith Grimwood, Wellington School of Medicine - 

Paediatric Review Group 

Emergency Services - MoH and HHSs 

Ian Civil, Auckland Healthcare Trauma Surgeon 

Geoff Hughes, Capital Coast Health Emergency 

Medicine Specialist 

Jim Ross, Oxford GP 

Sarah Little, Starship ED nurse 

John Ayling, CEO Ambulance Board 

Anne-Marie van der Linden, ACC 

Deborah Woodley, MoH 

Diabetes 

Paul Curry, Chair Wellington Diabetes team 

Dr Jo Baxter, Maori Doctors Ti Ora 

Valerie Brown, Maori Provider 

Dr Jan Bryant, Maori GP 

Dr Kirsten Coppell, Public Health specialist 

Dr Rick Cutfield, Diabetes specialist 

Norma Haley, Diabetes Youth 

Margaret Jamieson, Diabetes New Zealand 

Dr Tim Kenealy, GP 

Dr Helen Lunt, Diabetes specialist 

June Swindells, Maori provider 

Maxine Tangihaere, Maori Provider 

Dr Colin Tukuitonga, PI public health 

Suzy Whitcombe, Diabetes nurse educator 

Donna Richards, Te Roopu Mate Huka 

Dr Ashley Bloomfield, MoH 

Tamariki Ora/Well Child and Immunisation 

Technical Advisory Group 

Angela Baldwin, Plunket Society, Wellington 

Anna Bailey, Health Star Pacific 

Brett Austin, Plunket Society, Auckland 

Carol Stott, Child Health & Family Services 

Auckland Healthcare 

Dr Tueila Percival, C/- Middlemore Hospital 

Matapihi Kingi, Tipu Ora Rotorua 

Matea Gillies, Ngai Tahu 

Q. Mahanga, Hauora Whanui 

Marion Guy, NZNO Practice Nurse 

Nick Baker, Paediatric Society 

Pat Tuohy, Ministry of Health 

50

Dr Tim McKenzie, GP Wellington, NZMA 

Reg Ratahi, Waipairera Trust 

Morehu MacDonald 

Palliative Care - HHSs, NHSC, Hospice providers 

and community interest groups 

Dr Rod McLeaod, Mary Potter Hospice 

Ms Jan Nichols, St Josephs Hospice 

Ms Robin Steed, Health Waikato 

Ms Janice Wenn, Whaiora Whanui 

Dr Mark Jeffery, Canterbury Health 

Ms Maggie Barry 

Dr Brian King, GP 

Mr Mervyn Monk, Hospice NZ 

Roadside To Bedside Emergencies Focus Group 

Maggie Banks, NZCOM 

Ann Yates, NZCOM 

Heather Muriwai, NZCOM 

Tim Malloy 

Barbara Beckford 

Rob Sinclair, The Order of St John 

Miriama Kupe, Nga Maia 

Corrina Vaughan, Nga Maia 

Al Haslam, NZMA 

Phil Weston, NZMA 

Ultrasound Utilisation Review Committee 

Carey Virtue, NZCOM 

Sandy Grey, NZCOM 

Teenah Handiside, Federation of Women’s Health 

Councils 

Graham Parry, NZMA 

Robert Sim, RANZ College of Radiologists 

Dr Nigel Anderson, RANZ College of Radiologists 

Miriama Kupe, Nga Maia 

Joanne Rama, Nga Maia 

Dominic Stayne (analyst for committee) 

Paediatric Specialty Services Review Project 

Group 

Dr Nick Baker, Paed Society 

Prof Barry Taylor, Paed Society 

Dr Scott McFarlane, Paed Society 

Prof Keith, Grimwoodd Paed Society 

Dr Adrian, Trenholme Paed Society 

Dr Pat Touhy, MoH 

Nicky Shave, Nurses Advisory Group 

Technical Working Groups within 

Health and Hospital Services 

The HFA has formed a large number of Technical 

Working groups with HHS. These comprise HFA 

and HHS staff as follows: 

Pricing Group (Price Path) 

Determines aggregate start point of HHS revenue 

(based on 1999/2000 actual) and the price path 

forward to aggregate 2000/2001 revenue. Price path 

is the net of an inflation adjuster and an allowance 

for efficiency gains in the sector. 

Nigel Dewar, Lakeland Health 

Stuart Powell, HFA 

Andrew Gaudin, CHA 

Chris Hoar, Canterbury Health 

Sally Rennie, HFA 

Weiguo Ding, HFA 

Justine Tringham, Auckland Healthcare 

Chris Dyhrberg, Capital Coast Health 

David Green, HFA 

John Bates, HFA 

Nigel Cunningham, Coast Health Care 

Peter McIntosh, Coast Health Care 

David Chrisp, HFA 

Base Volumes 

Provides a variety of volume data sets (eg contract, 

actual, national intervention rates) to inform the 

discussions between localities and HHSs to arrive 

at 2000/2001 contract volumes. 

Julie Wilson, Health Waikato 

Martin de Boer, HFA 

Dr Gary Jackson, South Auckland Health 

Geoffrey Forbes, HFA 

Owen Wallace, Pacific Health 

Jan Parker, HFA 

Mark Spittal, Canterbury Health 


Shane Davidson, Canterbury Health 

Ron Craft, HFA 

Nigel Kee, HFA 

Paul Howard, HFA 

Ian Westbrooke, HFA 

Joy Christison, HFA 

Mark Batt, HFA 

Elizabeth Butturini, Hutt Valley Health 

Zoran Bolevich, Good Health Wanganui 

Tim Wood, HFA 

Janice Donaldson, HFA 

Jesse Kokaua, HFA 

Cliff la Grange, Waitemata Health 

Dr Phil Hider, Department of Public Health and 

General Practice, Christchurch School of Medicine 

Capital Cost 

Proposes a way of incorporating depreciation, 

interest and capital cost into prices. 

Andrew Gaudin, CHA 

Stuart Powell, HFA 

Graeme Edmond, Auckland Healthcare Services 

Ian Ward, Auckland Healthcare Services 

Warren Young, Hutt Valley Health 

Jonathon Jourdain, HFA 

Steve Anderson, CCMAU 

Chris Fleming, Healthcare Hawkes Bay 

Ian Ward, Auckland Healthcare 

Murray Gerogel, Midcentral Health 

Peter Beirne, Midcentral Health 

Chai Chuah, Canterbury Health 

Rochelle Leahy, Hutt Valley Health 

Andrew Powell, Capital Coast Health 

Terry kendall, Health Waikato 


Pranay Lodhiya, Good Health Wanganui 

Perry Kendall, Health Waikato 

Benchmarking (an HHS project) 

Identify sector benchmarking objectives and 

develop a proposal to meet them. 

Brenda Bromell, Health Waikato 

Gary Koppes, Coast Health Care 

Fay Logan, Healthlink South 

Zoran Bolevich, Good Health Wanganui 

Rosemary Jarmey , Capital Coast Health 

Darma Black, Capital Coast Health 

Leigh Monks, Good Health Wanganui 

Megan Boivin, Healthcare Otago 

Teresa Chalecki, Coast Health Care 

Sharon Pearce, South Auckland Health 


Andrew Powell, Capital Coast Health 

Helen Wood, HFA 

Brent Wiseman, Health Waikato 

Jim Knight, South Auckland Healthcare 

Michael Rains, HFA 

Tony Hickmott, Auckland Healthcare 

Bottom up costing (an HHS project) 

Seeks to compare relative performance of HHSs 

based on costing information derived from HHSs 

using the common costing standards. 


Roy Chan, HFA 

Roger Lamond, Healthlink South 

Paul Taumanu, Health Waikato 

Ron Craft, HFA 


Nigel Cunnigham, Coast Health Care 



Rosemary Jarmey , Capital Coast Health 


Glen Munro, HFA 

Maureen Chrystal, Auckland Healthcare 

Common costing standards (an HHS project) 

Seeks to provide HHS product cost data that can 

be used to inform pricing and benchmark 

performance. 

Leo Hulme, Healthlink South 


Roy Chan, HFA 

52


Glen Munro, HFA 

Jim Knight, South Auckland 


Paul Conder, Pacific Health 

Harry Barber, Tarawhiti Healthcare 

Chris Fleming, Healthcare Hawkes Bay 



Janice Bromell, Nelson-Marlborough Health 

Ray Anton, Healthcare Otago 

Rod Brown, Southern Health 

Andrew Boyd, Deloitte 

Andrew Gaudin, CCMAU 

Cost weights 

Aims to improve cost weights (inpatient and 

outpatient) used in HHS prices 


Rochelle Leahy, Hutt Valley Health 


Alistair Ayto, South Auckland Health 

Roy Chan, HFA 



Estelle Muller, HFA 




Kevin Sharkey, Capital Coast Health 



Nigel Trainor, Nelson-Marlborough 

Gina Banfield, Auckland Healthcare 

Linda Fletcher, Auckland Healthcare 

Clinical Training Agency 

Aims to improve CTA prices in respect of the 

allowance for overhead costs built into prices and 

a price path adjustment. 

Tony MacDonald, Healthlink South 


Data Improvement and Management 

Aims to identify and resolve HHS sector data issues 

Chris Hoar, Canterbury Health 


Ian Westbrooke, HFA 

Darren Wilson, Healthlink South 




Glenys Checchi, Capital Coast Health 

Sean Callis, HFA 

David Scott, HFA 

Warren Jackson, Good Health Wanganui 


Marjorie Anderson, South Auckland Health 

Paul Howards, HFA 


Jenny Murray, Taranaki Health 

Robyn MacIntosh, HFA 

Jason Whakaari, HFA 

Janice Brommel, Nelson-Marlborough 

Helen Watson, HFA 


Health and Disability Sector Standards 

Aims to assess the impact of the implementation 

of Health and Disability sector standards on HHSs 

and to prepare a guide to assist their effective 

adoption within the sector 

Janice Lavelle, Healthlink South 

Jane Cartwright, Healthlink South 

Raewyn Wolcke, Auckland Healthcare 

New Purchasing Approaches 

Aims to identify a ‘toolkit’ of new purchasing 

approaches 

Jane Parfitt, Healthlink South 

Neil Woodhams, Auckland Healthcare 

Patient Transfer 


John Phibbs, Auckland Healthcare 


John Mitchell, Healthlink South 

Tracey Adamson, Healthcare Hawkes Bay 

Clare Connell, HFA 


Lisa Lim, HFA 


Naree Nevill, Capital Coast Health 

Paul Greertson, Good Health Wanganui 

Denise Clement, Nelson-Marlborough 

Purchase Units and Service Specifications 

Develops purchase units and service specifications 

consistent with a set of national principles. 

Chris Crane, HFA 

Wendy Hoskin, Health Waikato 

Loraine Milne, HFA 



Trish McFadden, Capital Coast Health 

Jan Barber, HFA 

Kristin Wilkinson, South Auckland Health 


Marin de Boer, HFA 

Robbie Thomson, HFA 

Peter McIntosh, Coast Health Care 

Rosalie percival, HFA 

Chris Lowry, Good Health Wanganui 

Wendy Beverley, Capital Coast Health 

Louise Carr, HFA 




Rural/diseconomy 

Aims to identify ways of compensating HHSs for 

costs related to the provision of services in rural 

areas and incurring diseconomies of scale that are 

not adequately reflected in the national price book. 

Julie Rodgers, Nelson Marlborough 


Robin Steed, Health Waikato 


Robbie Thompson, HFA 


Bev O’Cain, Healthlink South 

Nigel Kee, HFA 



Rod Brown, Southern Health 

Nigel Trainor, Nelson Marlborough 


Tertiary adjuster 

Aims to identify ways of compensating HHSs for 

costs related to the provision of tertiary services 

that are not adequately reflected in the national 

price book. 

Chris Dyhrberg, Capital Coast Health 

Jonathon Jourdain, HFA 

Justine Tringham, Auckland Healthcare 

Sean Callis, HFA 


Dr Gary Jackson, South Auckland Health 

Bob Bishop, HFA 


Lisa Lim, HFA 






Janice Lavelle, Healthlink South 

Jane Cartwright, Healthlink South 


Nigel Trainor, Nelson Marlborough 



Service Reviews 

A “Service” is an identifiable health or disability 

service, or part thereof, which a health provider is 

funded to deliver to specified consumers. It may 

be a defined health service such as oral health 

services or defined population based health service 

such as child health services, or a defined service 

in a geographic area such as immunisation services 

54

in Hawkes Bay. It may only be a component of 

one of these services, or a combination. 

Roy Chan, HFA 

Loraine Milne, HFA 

Margaret Ann Irwin, HFA 

Tim Wood, HFA 

Jan Barber, HFA 



Bev O’Cain, Healthlink South 

Brian Walden, Good Health Wanganui 


Marjet Pot, Auckland Healthcare 

Waiting Times Project 

Brett Solvander, HFA 

Erin Flood, HFA 

Gary Knighton, HFA 

Helen Williams, HFA 

Janice Kemp, HFA 

Marilyn Johnson, HFA 


Nigel Rickerby, HFA 

Philip Gander, HFA 

Ray Naden, HFA 

Valerie Meyer, HFA 

Vivienne Ong, HFA 

Nursing taskforce 

The HFA is trying to make policy changes to allow 

nurses to order lab and diagnostic tests and 

specialist referral rights and to allow nurses to 

purchase directly. Reprioritise for more Nurse-led 

services. Encourage better use of Practice Nurses 

within PCOs. Reprioritise to provide training for 

nurses in management and leadership. Also the 

HFA is trying to have more nursing advice into 

decision-making. 

Laura Lambie, HFA 

Marama Parore Katene, HFA 

Other work involves: repriortising for more nurseled 

services; encourage better use of practise nurses 

within primary care organisations; provide training 

for nurses in management and leadership; have 

more nursing advice into decision-making. 


Health — What’s Driving the Future 

The past decade has seen new health providers, 

particularly Maori, Pacific Islands communitybased 

and independent health providers become 

involved in servicing the health needs of our 

population. 

The healthcare provider market has changed 

markedly from what it was 10 years ago, primarily 

due to the introduction of the purchaser-provider 

split, and the opportunities this presented for new, 

diverse providers to enter the healthcare market. 

This change had the benefit of increasing the 

choices and methods of service delivery for 

patients, but also led to greater fragmentation. 

More recently there has been a leaning more 

towards management of providers by the HFA and 

the Personal Health group with the aim of 

improving integration and collaboration among the 

health providers at local level, in order that patients 

might benefit. 

The benefits can now been seen in the mix and 

choice of health providers the public and patients 

have access to. This situation is very different from 

what existed before. 

There are now more community and locallymanaged 

provider organisations, more Maori and 

Pacific Islands provider organisations which 

previously did not exist, and more multidisciplinary 

approaches to care. Care is less medically-centred, 

more holistic and focused on patient selfmanagement 

and informed choice, through health 

education and prevention strategies. 

Managing groups of providers requires increased 

organisation of care for consumers. Organisations 

delivering healthcare seek opportunities for greater 

efficiency. The HFA seeks greater value for money 

and accountability for the public spend on behalf 

of the Government, while ensuring quality and 

equity standards are consistent and maintained. 

At the same time, the sector and public of 

New Zealand, who are becoming better informed 

year by year, are pressuring the sector to provide 

more evidence around their care decisions, and 

more certainty about what they can expect from 

the public health system. 

The trends in the health workforce are also 

changing. For example, the makeup of the GP 

workforce is changing with the age structure 

decreasing. Figures show that the numbers of GPs 

under 45 years of age increased from 35.6 percent 

in 1980 to 61.7 percent in 1995. 1 There are higher 

numbers of female practitioners in part time 

practice, and there is a growing number of Maori 

practitioners – estimated to be around 200 in 1998 2 . 

The nursing workforce is changing. An increasing 

number of nurses are working part-time, and 

working for different types of providers rather than 

the historical pattern of working for hospitals or 

GP-based practices. Some are forming independent 

nursing organisations to provide care in the home 

and community, while others are being attracted 

to Maori and Pacific Islands health providers. 

Population and Demographic Trends 

The Personal Health group believes that 

demographic and related social trends will drive 

future change in the provision of health care, 

including: 

• Increasing total population: a projected increase 

from 3,714,000 in 1996 to 4,232,000 in 2021, 

mainly due to immigration and mostly in the 

North Island. 

• Increasing urbanisation, which has implications 

for the viability of rural healthcare and pressures 

urban services 

• Increasing ageing population, with numbers of 

elderly people projected to outnumber children 

by 2031 

• Declining birth rate, with the proportion of 

children in the population expected to decline 

from 23 percent in 1994 to 18 percent by 2031 

• Steady growth in the Maori population from 

434,000 in 1991 to 546,000 in 2016. At least 

84 percent of this growth will be in the North 

Island. Though improving, Maori are likely to 

continue to have lower socio-economic status 

and higher morbidity rates than experienced by 

the rest of the population. Maori population 

currently accounts for 15 percent of the NZ 

population. 

56

• Steady growth in the Pacific Islands population 

from 4 percent of the population in 1991 to 7 

percent in 2031 

(Source: Statistics New Zealand Demographic 

Trends 1998) 

These demographic trends will likely lead to a 

growth in the need for primary and secondary care, 

especially among the elderly and those with low 

incomes. 

As Maori and Pacific Islands populations grow, so 

will the need for enhanced services which more 

appropriately meet their needs. This will include 

a need for more healthcare services delivered and 

managed by Maori and Pacific Islands providers, 

including strategic and policy development around 

those services. 

The growing pressure from these communities to 

participate in the decision-making and delivery 

process has implications for the public sector 

infrastructure, and is a trend that the Personal 

Health group has been actively attempting to 

cater to. 

Health Status and Service Use 

New patterns of disease and changing patterns of 

existing diseases will continue to drive the 

healthcare sector. Particularly important is the 

increasing incidence of some infectious diseases as 

a result of antibiotic resistance and low socioeconomic 

status (e.g. living conditions, income 

levels) as well as age-related illness, chronic diseases 

and mental illness. 

The key determinants of health status are ageing, 

changing ethnicity, lifestyle choices, income and 

education, and the state of the environment. 

1 Clinical Training Agency 1995 

2 Personal communication, Te Ohu Rata o Aotearoa (Maori 

Medical Association) 

For more information you can contact the HFA’s information freephone on: 

0800 ENQUIRE (0800 367 8473). 

Alternatively, you may wish to visit our website at: 

http://www.hfa.govt.nz 

The HFA also runs a freephone number for information about Maternity Services: 

0800 MUM 2 BE (0800 686 223).

Document for PDF - Ministry of Health

Create successful ePaper yourself

Delete template?

Save as template?