Prof Gauld, an authority on healthcare systems, co-authored a report published last month which could not determine in full the basis for how some $9 billion is allocated each year through population-based funding (PBF). He was surprised he got virtually no reaction to the report, which raised questions about transparency, accountability and freedom of information.
Asked for his view of the report, Health Minister Tony Ryall provided a two-sentence reply to four written questions from the Otago Daily Times.
"Population-based funding was established under the previous [Labour-led] Government and it is periodically reviewed [after a Census].
"The National-led Government has increased funding to Vote Health by nearly $2 billion over four years," he said.
Prof Gauld believed Mr Ryall's response illustrated PBF was "politically difficult" for the two major parties. Since winning office in 2008, National worked with the system which was established by Labour in 2002.
Neither had much interest in questioning it, he contended.
Labour had a credibility problem. If it started making a noise about the health funding formula, it would be ridiculed for querying its own system.
Prof Gauld believed the issue was one that could "come back to bite a government".
Used to dish out more than two-thirds of health spending, PBF employed a complex formula to determine each district health board's share, he said. The formula uses a mix of historical, demographic, and geographic factors, but the methodology is not publicly available, even using the Official Information Act.
Funding discrepancies of 20% per person between the highest-funded (Whanganui) and lowest-funded (Capital and Coast) DHBs raised questions. While it might be legitimate to pay some DHBs more because of their population make-up, there should be a mechanism to explain how it worked, he said.
The report criticised the Ministry of Health for not being more forthcoming with data.
The report revealed the only major appraisal of PBF was in 2007, which was restricted to technical adjustments, and not a review of the formula.
