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Healthy Communities – Mauriora! Future Pressures on the Health System: Some Critical Factors Presentation to the 2012 Health and Disability Sector NGO-MoH.

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Presentation on theme: "Healthy Communities – Mauriora! Future Pressures on the Health System: Some Critical Factors Presentation to the 2012 Health and Disability Sector NGO-MoH."— Presentation transcript:

1 Healthy Communities – Mauriora! Future Pressures on the Health System: Some Critical Factors Presentation to the 2012 Health and Disability Sector NGO-MoH Forum Deloitte Lounge Westpac Stadium Wellington Thursday 29 th March Barry Smith (Te Rarawa, Ngati Kahu) Population Health Analyst Planning and Funding Lakes District Health Board

2 Healthy Communities – Mauriora! The three sides to every story: - yours - mine - and what’s really happening!

3 Healthy Communities – Mauriora! Four messages Given that forewarned is forearmed we should debate these matters now – and - in a fully transparent way We should examine options using a ‘slow policy’ process and avoid the reactive ‘dog bite’ approach How we deal with these (ethical) challenges will say a lot about us - our values - and the sort of society we want to live in Community based entities may end up ‘bearing the brunt’ of stresses felt elsewhere in the health system

4 Healthy Communities – Mauriora! “There will be increasing pressure to raise health funding levels - even under a philosophy of fiscal constraint” “Increasing numbers of older people will make spending on health difficult to control fiscally - but – especially – politically” “Continued use of the current ways of distributing the health dollar may widen health disparities - and so add social costs” “Explanations around individual health status will focus more on personal responsibility” “ [But] the major cause of financial stress on the health system may well lie with factors other than ageing” The dominant (global) narrative

5 Healthy Communities – Mauriora! Pressure Source 1: Changing population

6 Healthy Communities – Mauriora! Demographic picture for New Zealand (Source: Statistics NZ) Count 0% % % 12% Medium Growth Projections

7 Healthy Communities – Mauriora! Number in working population (15-65 yrs) for every person 65 yrs and over

8 Healthy Communities – Mauriora! Healthcare Cost by Age (Source: NZ Treasury, 2010)

9 Healthy Communities – Mauriora!

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11 Pressure Source 2: Changing technology

12 Healthy Communities – Mauriora! The impacts – positive and negative Positive Supports new thinking and new knowledge Can contribute to better health outcomes if access is only needs driven Negative Often adopted before being ‘fully tested’ New treatments can worsen health disparity if access is not needs based Enthusiasm can override appropriate application [Generally] raises costs to the health sector So - how should we balance cost against ‘progress’?

13 Healthy Communities – Mauriora! Pressure Source 3: Changing workforce

14 Healthy Communities – Mauriora! Some questions Does use of language like “front-line services” etc. over simplify the way the health system works? Are we making ‘savings’ just to meet rising costs in other parts of the health system? How will regionalisation and centralisation impact communities in provincial New Zealand and just what should be regionalised? Should control and accountability be located in the same or different places? What should the future skill-mix in the health sector look like and will decisions be driven by equations of cost or need?

15 Healthy Communities – Mauriora! Pressure Source 4: Changing inequality?

16 Healthy Communities – Mauriora! New Zealand life expectancy at birth (Source: Statistics NZ, NZ Life Tables, ) PeriodNon-Maori Males Maori MalesNon-Maori Females Maori Females

17 Healthy Communities – Mauriora! Life Expectancy Trends: Maori and Non-Maori (Source: MSD)

18 Healthy Communities – Mauriora! Amenable Mortality Rates (Source: MoH)

19 Healthy Communities – Mauriora! Inequalities by DHB (‘Bulletin 28’) (Source: Monitoring Health Inequality Through Neighbourhood Life Expectancy MoH Public Health Intelligence Occasional Bulletin No. 28, December 2005)

20 Healthy Communities – Mauriora! Age standardised death rates < 75 years FranceAustraliaJapanGermanyNew ZealandUnited KingdomUSA 1997– – – (Source: OECD)

21 Healthy Communities – Mauriora! The ‘glass half-full’ scenario Slower growth of the population under 65 years will provide opportunities to ‘re-invest’ elsewhere in the system Improving morbidity rates and ‘re-configured’ models of healthcare delivery will reduce pressure on available resources Better measures of ageing (e.g. the ‘old age dependency ratio’) will provide a more accurate picture of the social impacts of ageing ‘Distance from death’ measures will provide a more ‘optimistic’ picture of future resource demand

22 Healthy Communities – Mauriora! The ‘glass half-empty’ scenario Increasing life expectancy will generate increasing levels of disability and associated costs Social expectations around the level of available healthcare will rise as populations age Reconfigured models of health delivery will generate a net cost and so will not solve funding pressures [Thus] advantages from ‘morbidity compression’ will be lost

23 Healthy Communities – Mauriora! The melancholic optimist “There is a crack, a crack in everything, That’s how the light gets in” (Anthem) Leonard Cohen, b. 1934

24 Healthy Communities – Mauriora! Thinking about solutions: Models of resource distribution

25 Healthy Communities – Mauriora! Some critical questions How should we assess health need - and what definition should we use? Should all health gains count equally - and what about the ‘fair innings’ argument? Whose costs and benefits should we value most – should we focus just on the working population? Should we apply ‘discount rates’ to health care - and focus on improving system responsiveness?

26 Healthy Communities – Mauriora! Still more questions! Will we need a clearer definition of ‘adequate health’? What priority should we give to the ‘worst off’? Why don’t we just work on reducing health inequalities and focus less on ‘health maintenance’? How should we balance individual rights against broader social goals?

27 Healthy Communities – Mauriora! So - how should we carve up the cake? Models of social distribution Equality model – an equal portion to each Functional model – a portion proportional to need Reward model – a portion proportional to effort Social value model – a portion proportional to the contribution to society Meritocracy model – a portion proportional to merit

28 Healthy Communities – Mauriora! Thinking about solutions: The consequences of these models for the ways we spend the health dollar

29 Healthy Communities – Mauriora! Healthcare cost by age - current picture AGE FUNDING LEVEL

30 Healthy Communities – Mauriora! Healthcare cost by age – future picture AGE FUNDING LEVEL

31 Healthy Communities – Mauriora! Equality model - based on an equal share for all AGE FUNDING LEVEL The ‘needs – allocation’ gap

32 Healthy Communities – Mauriora! Reward model - based on current ‘productive effort’ AGE FUNDING LEVEL

33 Healthy Communities – Mauriora! Social values model - based on ‘contribution’ to society AGE FUNDING LEVEL

34 Healthy Communities – Mauriora! Meritocracy model - based on ‘social merit’ AGE FUNDING LEVEL

35 Healthy Communities – Mauriora! Functional model: - based on a current picture of health cost by age AGE FUNDING LEVEL

36 Healthy Communities – Mauriora! Neo-functional model: - based on re-configured need - the ‘bathwater effect’ AGE FUNDING LEVEL

37 Healthy Communities – Mauriora! ‘Right’ conditions for policy development? Value views from outside the sector Know more about ethics and social justice and evaluate policy directions accordingly Have wider more inclusive debates about definitions of need View health goals in terms of both collective and individual gains Take the issue of health inequality seriously Apply ‘slow policy’ methods rather than the reactive fragmented approach we seem to prefer

38 Healthy Communities – Mauriora! The policy maker’s lament!! Steven Gene Wold, b.1941

39 Healthy Communities – Mauriora! And so - back to the future


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