In health, the election has become a bidding war focused on
the new centre ground of free doctor visits.
National outmanouevred Labour in May with a Budget promise to
extend free GP visits and prescriptions to children under 13
from next July, at a cost of $30 million a year. Until then,
this had been the territory of the Greens -- and the Child
Poverty Action Group, which wants the extension of the
current free under-6s care to all school-aged children.
But now Labour has trumped National by adopting its under-13s
policy and extending it to the elderly, at an additional cost
of $120 million a year, including prescriptions.
More free care, including dental treatment, for pregnant
women is among a cluster of promised Labour additions to free
or low-cost primary care. The party says this would fund free
GP visits for nearly 40 per cent of the population - up from
12 per cent now - and nearly 30 per cent would get low-cost
The Greens want free primary healthcare for all children.
The idea of this state-funded largesse is to treat people
earlier to keep them out of more-expensive hospital care, and
there is some evidence to support this view.
Labour costs its primary care changes at $280 million a year,
and claims the Government's increases in health funding have
not kept up with the country's needs.
But the Government says it has managed efficiently in tight
financial times, increasing health spending from $12.6
billion in 2009/10 to $15.6 billion this financial year -
about $500 million a year including reprioritised spending.
New Zealand's spending on health rose by more than twice the
average rate among countries in the Organisation for Economic
Co-operation and Development from 2009 to 2011, according to
It was Labour in government a decade ago that introduced
universal subsidies for primary healthcare, a sector in which
state funding was previously more targeted.
Under Don Brash in 2005, National threatened to unwind the
policy, but later relented.
Under Health Minister Tony Ryall, since 2008 subsidies have
expanded for some but have been eroded by inflation for
others. He has made the free-under-6s concept - introduced by
Winston Peters in the late 1990s and achieved only partially
under Labour - a widespread reality. More than 95 per cent of
children in that age group now have access to free care,
including after hours.
But there are stress cracks in primary care. Rises in patient
fees permitted by district health boards since 2009 have
Labour cites a Statistics NZ brochure showing the average
cost to adults for a GP visit has risen by 24 per cent under
National, to $36.28 last year. No corresponding children's
charge is given, but a Health Ministry survey found it was
$21 in 2011/12 among children whose care attracted a fee,
while for 55 per cent there was no charge.
A Child Poverty Action Group survey last year found the
average cost for a child aged 6 to 17 to visit a GP during
office hours was $24. Individual charges ranged from zero to
After hours the average fee was $44, and the range from zero
The ministry's annual survey last year found 6.3 per cent of
children had missed out on a GP visit because of the cost in
the preceding year - up from 4.8 per cent in one year. Labour
claims there was an increase for adults too; the ministry
report indicates there may have been an increase, but it was
not statistically significant.
Labour also claims there is a "rising number of people
turning up to emergency departments because they can't afford
to see a GP" - and there is some evidence at least of rapidly
increasing demand at EDs although the reasons are not clear.
A doctor/manager admitted in papers for the Auckland District
Health Board that, even before the annual surge caused by
winter illness, its adult emergency department was
"struggling" to meet the Government's six-hour target for
"The ED is geared to manage 160 patients daily but in effect
has been managing in excess of 200 patients regularly in
Mr Ryall's six targets - EDs, elective surgery, cancer
treatment, immunisation, urging smokers to quit, and heart
and stroke risk checks - mark out his main achievements.
The groundwork for the big increase in child immunisation was
laid under Labour, but it is Mr Ryall's tight focus on
headline targets - Labour calls it his "obsession" - that has
driven change, especially in ED times and increased amounts
of elective surgery.
The amount of elective surgery increased in most of Labour's
nine years in power, but fell in some years.
Under National, elective surgery has surged. About 158,000
patients were treated last year, a 34 per cent increase in
five years, which was far greater than the population growth
rate. Further increases are promised, with an extra $110
million committed over four years.
Despite this, a survey for the health insurance industry
estimated last year that 280,000 people were "in need of
The industry says the public system cannot cope and needs
private sector help, partly because of an ageing population
needing more surgery and the decline, triggered by the
recession, in the number of people with insurance.
Mr Ryall's cancer target has reduced waiting times for
treatment, and he has funded a four-year trial of bowel
cancer screening in Auckland's north and west, building on an
idea proposed by Labour.
Labour leader David Cunliffe has promised to build the
Waitemata scheme into a national programme, at an initial
cost of $14 million a year.
His party says New Zealand - which has one of the world's
highest bowel cancer death rates - is lagging behind many
developed countries in not having a national screening
programme, which could save up to 180 lives a year.
National will wait for the Waitemata results before making a
decision on a national programme.
Population health - covering the likes of obesity, healthy
eating and exercise - is another area traditionally the
heartland of Labour and the Greens.
But National has shored up many of its weaknesses here with
schemes such as the rheumatic fever prevention programme and
child immunisation improvements.
Huge changes have occurred on tobacco control, thanks to MMP,
Maori Party co-leader Tariana Turia and Internet-Mana Party
co-leader Hone Harawira.
The percentage of people who smoke had dropped to 15 per cent
by last year, from 21 per cent in 2006. Tobacco tax
increases, the retail display ban and the proposal for plain
packaging have had wide support in Parliament.
Some public health practitioners have not fully recovered
from National's rapid abolition of many of Labour's efforts
to improve the country's food "environment".
National's instinct is the educational approach rather than
confronting the food industry, although many experts agree
this is unlikely to reduce New Zealand's obesity problem - we
are the third most obese of OECD nations.
Our adult obesity rate rose from 27 per cent in 2006/7 to 31
per cent last year. Child obesity rose from 8 per cent to 11
Labour would pass the Public Health Bill, which gives wide
powers to control the food supply to address diseases in
which food is a factor.
The Greens would require all food and drink sold in schools
to be nutritious and want a levy on "fizzy/soft drinks" that
would later be imposed on "other products that cause
significant health problems".
National, although opposed to regulating food for the sake of
obesity, has adopted an Australian scheme that has won praise
from one of the Government's chief public-health critics,
Professor Boyd Swinburn.
The Budget in May committed $40 million for the Healthy
Families initiative to operate for four years in 10
communities, including two in South Auckland and one in the
Professor Swinburn said the scheme in Victoria involved
talking to school principals and other leaders about "how
levers can be pulled to make it healthier for kids", such as
by altering the food available.
- by Martin Johnston, NZ Herald