Choose a New Zealand social policy issue (I suggest one covered in the course). Critically evaluate how effective New Zealand’s stance has been. Make sure you use empirical resources (e. g. statistics, existing research) and sustained theoretical reflection to substantiate your conclusion. A global social policy issue is that of healthcare and it’s distribution.
The structure of the New Zealand health and disability sector is currently a mixed public-private system by which the Minister of Health in conjunction with the government develops policy, supported by the Ministry and various ministerial advisory committees (Ministry of Health, 2011). Most of the day to day running and business of the health system, and around three quarters of the funding is administered by district health boards (DHBs), which plan, manage, provide and purchase health services for the population of their district (Ministry of Health, 2011).
This includes funding for primary care, hospital services, public health services, aged care services, and services provided by other non-governmental health providers including Maori and Pacific providers (Ministry of Health, 2011). This brief overview of the structure of the health system shows that it is structured in a way that healthcare in New Zealand comes from a range of different corporations and distributors, both publicly and privately funded.
This also infers that in order to be functional, it must be a very interactive system, in order to achieve the New Zealand Health Strategy framework for delivering health services, and achieves this through health distribution at a local and national level. This framework includes goals such as good health and well-being for all New Zealanders throughout their lives, timely and equitable access for all New Zealanders to a comprehensive range of health and disability services regardless of ability to pay, and an improvement in health status of those currently disadvantaged (Cheyne, O’Brien & Belgrave, 2005 pp. 25).
This essay attempts to evaluate how effective New Zealand’s stance has been in dealing with the extensive and complicated social policy issue of healthcare through looking at essentially whether this framework has been achieved, or is working towards being achieved, and that in the current economic climate, resources contributed towards healthcare are being used in the most beneficial and productive way. Healthcare policy in New Zealand has undergone some major changes in the past few decades.
Health policy before the 1990s was very localized with funding tied up in some specific areas more than others. Moreover the system had high levels of inefficiency within it, due to the growing population in some areas and migration, as well as this it was difficult to transfer funding and some parts of the health system remained seriously underfunded, particularly mental health, children’s health, and Maori and Pacific people’s health (Cheyne, O’Brien & Belgrave, 2005 pp. 214).
The cost of health care was also increasing with improvements in technology and medication, which left the state unequipped and unable to afford to fund universal healthcare. Thus the 1990s created room for the influence of the neo-liberal perspective to become the main driver of health policies, making individuals take more responsibility for their healthcare (Cheyne, O’Brien & Belgrave, 2005 pp. 216). However this approach took a turn with the election of the Labour government in 1999, which began the appreciation in health policy that poor health is undoubtedly tied to socio-economic factors.
This change has marked our health policy today, in which both public and private funding plays a part. Although there are still tones of neo-liberalism mixed into state policy and New Zealand society’s idea of health, which will be further discussed, there is still widespread belief that healthcare is a government responsibility even under National, which is a centre right political party. A large aspect of the New Zealand health social policy today is that regarding the Accident Compensation Corporation (ACC), through which the government funds accident services.
ACC provides compulsory, comprehensive, no-fault insurance cover for accident-related injuries to all New Zealanders and is referred to by the OECD as ‘social security’ (Ministry of Health, 2012). In 2008/09, funding from ACC accounted for approximately 9. 7% ($1,820. 2 million) of total current health expenditure. This decreased to 8. 4% ($1,669. 8 million) in 2009/10 (Ministry of Health, 2012). ACC is funded principally by levies collected from a range of sources, including employers, self-employed people, employees and motor vehicle licensing.
ACC also receives direct government funding to cover people who are not earning an income (Ministry of Health, 2012). Moreover Everyone in New Zealand is eligible for comprehensive injury cover: no matter what you’re doing or where you are when you’re injured, how the injury happened, what age you are or whether you’re working (New Zealand’s Accident Compensation Corporation, 2012). Thus these statistics show there is a significant amount of healthcare being given through ACC, and with very broad terms and little, if any, means testing.
Therefore if someone is to have an accident doing some kind of recreational activity, for example skiing, the cost of their injury and recovery will most likely be fully paid for through ACC and it’s various contributors. However these recreational activities leading to injury are predominantly problems of the middle class. Yet it is very socially and morally acceptable to receive this payment with an injury and not pay for it yourself despite the financial capability to do so.
As well as this taxpayers see it as appropriate and fair that their money goes towards this. While this happens very frequently in New Zealand with seemingly unlimited funds in this area, other areas of healthcare and other disadvantaged groups lose out as a result. The way in which neo-liberalism is present in New Zealand healthcare is less substantial than in other areas of social policy, such as welfare, however it is present nonetheless, this is shown especially through the dominance of ACC, outlined above.
In recent decades there has been a growing emphasis on the contribution of individual behaviour and social determinants of morbidity and mortality (Cheyne, O’Brien & Belgrave, 2005 pp. 215). Although the health social policy does account for societal influences and structural inequalities, this remains one major attitude in New Zealand. The neo-liberal approach remains to some extent in health with issues like obesity, however not with things like sporting issues.
Obese people are viewed as responsible and at fault for their situation, however taxpayers in New Zealand are happy to pay for sporting accidents or injuries through the ACC system. This highlights the marked moralization of health in New Zealand, where taxpayers see it justified to pay huge sums of money through the government towards accidental healthcare, although the predominant group being injured in such a way are the middle class. However when it comes to prevention for issues such as obesity, which is predominantly a lower class issue, there is very little willingness to provide funds.
This is due to the idea that society doesn’t view obesity as an issue due to socio-economic factors, but failure on a personal level, a clear example of neo-liberalism in New Zealand health policy. More funding towards reducing inequalities that create problems like obesity and increased likelihood of ill health in lower socio-economic groups, especially Maori and Pacific Islanders, would be putting better use to taxpayers money than ACC, however a huge shift in public opinion would have to happen in order for this to be a possibility.
The fact that funding is not already in this area is in itself an indicator of the moralization of health and individual attitudes about what they are willing to pay taxes towards. People do not want to pay taxes that go towards health for other groups in society however ACC is reasonable as it is a type of universal social security and thus covers the taxpayers directly. Another feature critical to the structure of New Zealand health policy is that it is substantially focused on the ambulance side of healthcare rather than the fence.
This means that more tax money and other government spending is used on cleaning up the consequences of bad health and accidents, for example ACC, than it is on preventative care. This point is reinforced by New Zealand taxpayer statistics, which show that spending in the health sector this year has increased 3. 2% overall from last year, however aspects that have shown a decline in spending are all preventative movements and public health campaigns, for example Public Health Service Purchasing showed a decrease of 11% (Hansen, Bjerring & Delaney, 2012).
This is a fundamental issue with the New Zealand health system as if more efforts were put into preventative public health policies, or spending put into aspects that contribute to health such as better housing, not only will people have an improved and more holistic healthcare system, less tax and government spending would be needed to contribute to the ambulance side of health.
Presenting health to the public as a holistic lifestyle and something of importance in many aspects of living would be beneficial in the long run for all of New Zealand and for government spending on things like ACC and expensive surgeries as the result of a long run of bad health. Thus although ambulance type of health care is needed at some level, if New Zealand put in more preventative action according to groups of need and addressing socio-economic factors, health in New Zealand would improve in effectiveness and cost, and as a result New Zealand health would have fewer inequalities and be fairer.
By doing this New Zealand could better achieve goals in their framework for health. On top of the following structural issues in New Zealand health policy outlined above, New Zealand and most Western developed countries are currently facing a large problem with the ever-increasing ageing population and how to fund and distribute their healthcare needs.
The state’s promise in the framework towards good health and wellbeing throughout life becomes a problem with the ageing population as this requires more and more funding, which could essentially be put to better use somewhere else. Moreover a greater proportion of the population is becoming older, thus average annual health service costs are much higher, for example in 1971, 8. 5 percent of the population was over 65. It is now 12 percent and is forecast to be 25 percent in 2050 (Health Funds Association of New Zealand 2004).
Obviously this is a large issue for New Zealand health policy with funds increasingly going towards elderly care rather than elsewhere. A number of changes have been implemented in order to prepare for the greater number of elderly people to care, for example there has been a focus on increasing productivity in the are areas of aged care, pharmaceuticals and hospitals to deal with increased demand and to make the care of the elderly affordable within existing funding (Health Funds Association of New Zealand 2004).
Although care for the elderly is managed relatively effectively through the healthcare system in New Zealand, with public funding, or alternatively private health insurance to avoid large waiting lists for those that can afford it, there is an inevitability of increased funding for this area. The increase in spending in this area of healthcare will mean that other areas of government expenditure will lose out, such as early childhood and compulsory education (Health Funds Association of New Zealand 2004).
Moreover as so much health expenditure becomes concerned with the elderly, and state expenditure becomes increasingly directed into healthcare, support for other groups that are disadvantaged such as those relatively young Maori and Pacific populations may be comparatively reduced (Cheyne, O’Brien & Belgrave, 2005 pp. 227). As the elderly are also more inclined to vote and thus have a large political voice, it is very unlikely that they as a group will not receive adequate state funding towards their health care in the future.
In New Zealand, a political strategy that promises free health care for the elderly is essential, and is certain to gain votes, however policies that instead direct these funds towards free childcare, or free health care for disadvantaged groups such as Maori and Pacific populations simply would not gain the same political power. As another option for change increasing taxes for the working population could help fund the ageing population’s healthcare however this is also a very unpopular political strategy.
Thus the distribution of healthcare is a major problem for the future of New Zealand’s health social policy, as it is highly unlikely that those voting will make any kind of change towards less healthcare for them, and more for other groups. Another important issue faced in New Zealand health policy today is the way in which it is dealing with inequalities in health for people of lower socio-economic status, and especially Maori and Pacific populations.
Relatively recent policy changes have acknowledged that Maori are worse off due to socio-economic factors and disregarded the neo-liberal approach, and taken social democratic assumptions about social inequality and its impact on health status, and in particular the special needs of Maori, into consideration, making Maori health the lead concern in the Primary Health Care Strategy (Cheyne, O’Brien & Belgrave, 2005 pp. 226). Now there is evidence of improvement in health outcomes in New Zealand over the past decade, together with better rates of immunisation (Smith, 2009).
Despite this however there are still large inequalities and Maori health status remains significantly lower than that of Pakeha New Zealanders, which is shown through many health statistics, for example the average Maori life expectancy is 72. 8 for males, and 76. 5 for females, compared to 80. 2 for non-Maori males, and 83. 7 for females (Statistics New Zealand, 2013). However the difference in life expectancy between the two groups has actually decreased, to 7. 3 years compared to 8. years in 2005–07 (Statistics New Zealand, 2013).
Although this does show an improvement, aid in other areas are required to reduce inequalities for Maori and also Pacific populations. New Zealand’s policy of the local distribution of health, and centers directed at Maori and Pacific people specifically are a good way of ensuring that the distribution of healthcare gets to these people, however with the elderly needing more and more funding, it is essential for funding to continue to go to these areas.
Moreover greater equality in health outcomes is seen as a consequence of a large number of other factors, such as better housing, better nutrition, and greater equality of income, and not just achieved through more equitable or more universal access to medical technology (Cheyne, O’Brien & Belgrave, 2005 pp. 216). As well as this common attitudes of other New Zealanders need to change along with the acknowledgement from New Zealand health policy that the system has failed these groups, and it is not simply due to individual failure that they are in this position.
This is needed to ensure funding to this area continues through public support and taxes, if not inequalities are sure to continue. Social policy as a whole needs to be considered in order to make a change to the structural inequalities that have led to poorer health outcomes for these groups, and although healthcare itself is taking steps towards making this happen, other aspects of social policy, and everyday attitudes and practices need to take the same action to ensure change.