Document for PDF - Ministry of Health

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.
Personal Health’s Action
• 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.
Personal Health’s Action
• 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.
HFA Improving Our Health 31