Health Service Delivery Profile. New Zealand. Developed in collaboration between. WHO and the Ministry of Health, New Zealand

Transcription

1 Health Service Delivery Profile New Zealand 2012 Developed in collaboration between WHO and the Ministry of Health, New Zealand

2 New Zealand health service delivery profile Health situation and demographics New Zealand (Aotearoa) is an island country in the southwestern Pacific Ocean, comprising two main islands and numerous smaller islands. New Zealand is situated 1,500 kilometres (900 mi) east of Australia across the Tasman Sea, along the Pacific ring of fire, thus is prone to a range of natural disasters. In 2012 the population of New Zealand is 4,441,300; 20.46% under 15 years of age, and 13.02% over 65 years of age. 86.2% of the New Zealand population live in urban areas and urbanisation is increasing. In 2006, 67.6% of the population identified themselves as of European or other ethnicity, 13.64% Māori, 6.42% Pacific and 8.56% Asian. New Zealanders are living longer, and in better health. Medical and technological advances mean new opportunities and changing public expectations. The Ministry of Health (MoH) continues to meet the challenges presented by an ageing population and technological change in a timely way. There is likely to be continued pressure for increased efficiency and reduced costs for the foreseeable future. The New Zealand health sector continues to deliver results and control its funding path, It is essential that the health sector has the right tools and processes; that the people and organisations within the sector are coming together; and that patients are placed at the centre of the system, with their health and wellbeing the overall focus of the endeavour. New Zealand uses the term clinical integration to describe the confluence of these concepts. Clinical integration is the principal means of improving our ability to address complex health needs and protect good health and wellbeing, particularly in older age. Integrated approaches to care and service delivery put the patient at the centre of decisions. It can also contribute to the seamless transfer of patients through the different parts of health system, and can be accompanied by moving services to locations that are convenient to the patient. Table 1. Key development indicators for New Zealand Key development indicators Measure Year Human development index Gini index Gender equity Literacy rate 99% 2011 Poverty: a fixed line measure of 60% of median income, adjusted for housing costs, 15% of the total population living below this income level 1i 2010 Total health expenditure as % GDP 9.7% GDP 2009 Life expectancy at birth 81 years 2010 Infant mortality rate 4.9 per 1000 live births 2010 Maternal mortality rate 15.8 per 100,000 live births 2009 Four non-communicable diseases: cancer, cardiovascular disease, diabetes, and chronic respiratory diseases, make up 80% of the disease burden in New Zealand and communicable diseases continue to be significant. Mental health problems are a significant issue, and New Zealand s youth suicide mortality rate is the highest in the OECD. Dementia prevalence is increasing due to an ageing population. There are marked differences in health experiences among different groups within New Zealand s population. 1 1 Household Incomes, Inequality and Poverty, Dec 2011, NZ/ParlSupport/ResearchPapers/e/3/e/00PlibCIP181-Household-Incomes-Inequality-and-Poverty.htm Health Service Delivery Profile, New Zealand

3 Health system strategies and objectives In his Statement to Parliament on 8 February 2011, the Prime Minister emphasised the Government s focus on building better results from the public services New Zealanders rely on and building the foundations for a stronger economy. Following the general election in November 2011, the Government reinforced and expanded its priority areas to focus on: delivering better public services within tight fiscal constraints delivering responsible management of government finances, with the goal of returning to surplus in 2014/15 rebuilding Canterbury Building a more competitive and productive economy. The health and disability system, and consequently MoH as the lead agency for the health sector, is a major contributor to delivering on these priorities. In June 2012, under the Better Public Services priority area, Government also introduced 10 key result areas to be achieved by Within these key result areas, MoH is leading work on the areas of immunisation and the reduction in cases of rheumatic fever among children, and is also contributing to others. The Ministry is the government s principal advisor on health and disability policy. The National Health Board is a business unit of MoH and is responsible for funding, monitoring and planning of DHBs and designated national services, and for national, regional and local integration. DHBs are responsible for assessing their population health needs and providing or funding the provision of health services to meet those needs. They produce annual plans and collaborate with other DHBs to produce regional service plans. The Minister of Health appoints some DHB board members and communities elect DHB Board members, and there are community representatives on all DHB and PHO Boards, including Māori representation. Board members are accountable to the Minister of Health. Some DHBs undertake consultations with particular community groups about their health needs. The large number of small community-based NGO health providers, mostly Māori providers, have a strong community involvement in governance and planning. Consumers are able to complain about any health services to the Health and Disability Commissioner. The Minister of Health has identified four health-specific priority areas for MoH s short- and medium-term work programme. These reflect the Government s broader priorities, but also create a sharper focus on critical areas within the health and disability system: bringing health services closer to home improving the health and independence of older people strengthening the health workforce improving value for money. On 4 April 2012 the Prime Minister announced a new priority cross-government Youth Mental Health project. The project comprises a suite of initiatives designed to improve services for young people aged 12 to 19 years with, or at risk of, mild to moderate mental health issues. The 22 initiatives have been designed to build on strengths in current service provision and address areas where there are gaps. The aim of the project is to achieve better mental health and wellbeing for young people. It particularly focuses on those vulnerable groups known to be at comparatively higher risk of mental health issues, such as young Māori and Pacific people. Service delivery model All New Zealand residents have access to public services, as described in the Health and Disability Services Eligibility Direction There is a strong recognition in New Zealand that the social and cultural acceptability of health services are key aspects of health service accessibility. The New Zealand Public Health and Disability Act 2000 clearly outlines the roles and responsibilities of DHBs in this respect. This includes mechanisms within the Act that enable Māori to contribute to decision-making on, and to participate in the delivery of, health and disability services. Health and disability services in New Zealand are delivered through a large, complex and dynamic network of organisations and people, all of which play a role in contributing to New Zealanders living healthier, more independent lives. The devolved nature of New Zealand s health and disability system Health Service Delivery Profile, New Zealand

4 means that responsibility and authority for service funding and planning occurs at national, regional and local levels. New Zealand s health system provides access to all major types of health services, including child health, maternity, public health, community pharmacy, Māori health, specialist medical and surgical services, community referred tests to hospitals, mental health, disability services, national services, smoking cessation services, community/domiciliary, emergency services, oral health, primary health care, transplants, and health of older people. The Operational Policy Framework (included in District Health Board Crown Funding Agreements) sets out the business rules, policy and guideline principles that outline the operating functions of DHBs. New Zealand s Nationwide Service Framework (NSF) documents the service delivery model. The NSF is a collection of definitions, processes and guidelines that provides a nationwide approach to the funding, monitoring and analysis of services. It includes: the Service Coverage Schedule that sets out Government expectations for national minimum services in terms of range, coverage in terms of access, user charges, and quality and safety standards, and includes eligibility criteria; and, Service Specifications that include a detailed description of the components of the service to be delivered, linkages and reporting requirements, and ensures that these are consistent, equitable, accessible and of appropriate quality to meet minimum requirements. Patients can choose to enrol with a primary healthcare organisation (PHO), and 96% of New Zealanders are currently enrolled. PHOs may serve specific populations (e.g. Māori or low income), and several PHOs can co-exist in the same area. Private specialists and other complementary health providers operate without government funding (unless they have a contract with a DHB, or provide a service to an injured patient covered under the Accident Compensation Corporation), and are not required to service a particular population. The provider network District health boards (DHBs) are the largest funders and providers of health services. Around 75 percent of Vote Health funding is administered by DHBs. They are responsible for planning, managing, providing and purchasing services for the populations in their districts and regions, including services delivered in communities such as primary health care, residential services, home support and community care services. The majority of these community-based services are delivered by non-government health providers, including Māori and Pacific providers. There are also many government and non-governmental entities with quality, training, regulatory, purchasing and planning roles. These include PHARMAC, the Health Quality and Safety Commission, primary health organisations (PHOs), 16 Health Regulatory Authorities, and a range of professional colleges and other training bodies. There are also many workforce and consumer bodies that provide support and advocate for the interests of various groups, alongside more formal advocacy (such as from unions), committees and organisations. In addition, the government funds and co-ordinates health emergency planning and response, the combined emergency (police/fire/ambulance) number 111, a free, 24-hour telephone health advice service staffed by registered nurses, highly specialised, low-volume services such as adult and paediatric congenital cardiology, clinical genetic services and paediatric oncology, child health services, including school and preschool and outreach immunisation services. These are delivered by a mix of national and local providers directly contracted to the MOH. There are approximately 275 Māori health and disability providers contracted to DHBs that are Māoriowned, Māori-governed and deliver services mostly, but not exclusively, to Māori. Although each Māori health provider is different they can generally be characterised as three types of provider: small providers focusing on one kind of health service (e.g. smoking cessation, rongoā), comprehensive providers that offer a mixture of personal and public health services (e.g. public health, primary care, mental health, general practice), integrated providers that offer a range of health and social services (e.g. housing, family support and education linked programmes as well as comprehensive health services). Thirty-nine Pacific health providers deliver services to the Pacific population. Health Service Delivery Profile, New Zealand

5 Table 2. Summary of health services and providers in New Zealand Health promotion and disease prevention Environmental health 12 DHB-owned public health units (PHUs) Communicable disease control Tobacco control Health promotion Health protection Local government authorities Environmental health (some) Health promotion Screening Immunisati on Oral health services All levels: nationally by the MOH and NGOs and the Health Promotion Agency (HPA) (the HPA has been established to lead and deliver innovative, high quality and cost-effective programmes that promote health, well-being and healthy lifestyles, disease prevention, illness and injury prevention), regionally through DHBs and PHUs, and locally through Primary Health Organisations (PHOs), and NGOs, and Māori and Pacific health providers. Approved national screening programmes (currently breast, cervical and pregnancy/newborn screening) are provided through a range of providers contracted by the MOH Immunisations on the national immunisation schedule are provided nationally by the MOH and through a range of DHB providers and PHOs Provided for all children up to age 18 through school dental clinics, mobile dental units, through registering with a private dental practitioner or privately funded through health insurance. Emergency /hospital dental care provided for some low income adults. Primary care and community services Primary care services Community services Ambulance Child health Mostly delivered through general practices, many privately owned, which are members of a PHO. PHOs vary in size and structure, are not-for-profit, and provide services either through provider members or directly by employing staff. A few GPs remain unaffiliated with PHOs and operate independently. GPs, via PHOs, receive capitated funding to subsidise enrolee services, and additional per capita funding for health promotion, for coordinating care and providing additional services for chronic disease patients, and for reducing barriers for patients that experience access difficulties Many Māori and Pacific providers provide primary care and are members of PHOs that may receive higher per capita funding in order to improve access. Many community services are delivered by NGOs through national contracts or contracts with DHBs, and Māori and Pacific health providers Community services are also provided by a range of private practitioners, including most allied health professionals, who patients can access at any time without a referral but also without any government funding subsidy Secondary and tertiary services Inpatient, and outpatient services Medical Surgical Maternity Diagnostic Emergency services Long-term care services Aged care services Community outreach services from hospitals Long-term care and rehabilitation Public hospitals provide a variety of publicly funded health and disability services The range of services offered by an individual hospital is affected both by the size of the local population and the services offered by other hospitals in the region from tertiary referral centers to small rural hospitals staffed by GPs Some hospitals provide exclusively maternity or inpatient mental health care. Private and NGO hospitals provide some general hospital services, mostly elective services and may provide specialised care in dedicated units (for example hospices, endoscopy/surgical services). Residential aged care and in-home care Administered by a mixture of private and NGO providers Home Support services may be provided on a short-term acute or long-term maintenance basis. These services include both personal care (bathing, meals, feeding, grooming) and home help (cleaning, laundry etc.) DHBs provide generalist and specialist community nursing services, including complex wound care, IV therapy and enteral therapy, continence, stomal, palliative and home oxygen. DHBs fund long-term care for patients based on needs assessments, various age requirements, and a means test. Those eligible receive comprehensive, fully funded services, including medical care. Health Service Delivery Profile, New Zealand

6 Figure 4. Structure of the New Zealand health system Health Service Delivery Profile, New Zealand

7 Health financing Despite the constrained fiscal environment, New Zealand is one of only a few OECD countries to have increased its total health spending in recent years with 3.4 percent growth in spending between 2010 and New Zealand s rate of growth is higher than other countries often compared to, such as the UK, Canada and other northern European countries. At the same time, MoH has reduced its own operating budget from an annual expenditure of $205 million in 2010/11 to $191 million in 2011/12. In 2010/11, 83.2% of total expenditure on health was publicly funded, 10.4% came from Out Of Pocket payments, 4.9% from private health insurance (held by approximately one-third of New Zealanders) and the remainder from not-for-profits (philanthropy). Publicly funded expenditure on health comprised 89.5% central government funds (the dominant source being general taxation revenues at 51%), 10.1% accident compensation levies (and 0.4% local government funds. The Ministry of Health allocates more than three-quarters of the public funds it manages through government health funding (Vote Health) to district health boards. District health boards use this funding to plan, purchase and provide health services within their areas, including public hospitals and the majority of public health services. Most of the remaining public funding provided to MoH (approximately 20 percent) is used to fund important national services such as disability support, public health, specific screening programmes, mental health, elective services, Well Child and primary maternity services, Maori health and postgraduate clinical education/training. All New Zealand residents have access to public services, as described in the Health and Disability Services Eligibility Direction Health promotion and disease protection, public hospital care, outpatients, and some community care, and palliative care services are free of charge and services such as primary care, long-term care and pharmaceuticals are heavily subsidised by the government. Health care is provided free to pregnant women and children under 6 years old. For the rest of the population, the size of government subsidies depends on age and the level of income. Low-income residents and high health service users are eligible for additional subsidies. Independent private practitioner services, including adult dental health care and allied health, are paid for by Out Of Pockets or private insurance, or ACC (Accident Compensation Corporation) if applicable. Private insurance is mostly used to cover co-payments, elective surgery in private hospitals, and private specialist outpatient consultations. Those with insurance using the private sector gain much quicker access to procedures and specialists that are also provided in the public sector. There is no common fee schedule among private insurers, which are a mix of not-for-profit and for-profit enterprises. Insurers reimburse providers who claim payment for services up to company-specific maximums. The ACC provides comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand. It will pay for the treatment, rehabilitation and compensation costs for anyone who sustains an injury, regardless of whether the person was covered by other insurance policies. Human resources Based upon practising certificates issued from regulatory authorities New Zealand had 3.06 practising medical practitioners per 1,000 in 2011 which is an 8 percent increase on the 2007 rate of In 2011 statistics show that 56 percent of practitioners had a specialist qualification up nominally from the previous year. In general, private service waiting times are minimal and medical resources match the workforce numbers demanded by District Health Boards, however New Zealand does experience some medical shortages in some specialities in some areas. These shortages usually occur in smaller less densely populated areas. In 2011, 77% of new medical registrations were from international medical graduates, raising the total proportion of New Zealand s international medical workforce to 41.5 percent. Over the same period nurses grew nominally from 10.5 nurses per 1,000 in 2007 to 11.0 nurses per thousand in General nursing resources are currently sufficient for workforce demand in nonspecialist areas. 50% of new nursing registrations in New Zealand came from internationally qualified nurses. The Health Practitioners Competence Assurance Act 2003 provides a framework for the regulation of all health practitioners, including registration and competency certification. Currently 21 health professions come under this act. National clinical guidelines are developed by the independent New Zealand Guidelines Group and adapted in a Primary Care Handbook for GPs. Health Service Delivery Profile, New Zealand

8 Medicines and therapeutic goods The Pharmaceutical Management Agency (PHARMAC) is the New Zealand Crown agency that decides, on behalf of DHBs, which medicines and related products are subsidised for use in the community. PHARMAC manages the Pharmaceutical Schedule of about 1,800 government-subsidised community pharmaceuticals and some medical devices for hospitals, including setting subsidies and prices, and promotes the optimal use of medicines. It has helped drive down pharmaceutical costs and, as a result, New Zealand has around the lowest drug expenditure per capita in the OECD. If patients prefer unsubsidized medicines, and there are no clinical indications for this, they pay the full cost. Referrals and linkages in the provider network Entry to the health system is through direct access or referral. Patients can make an appointment to see a GP without a referral. A referral from a GP (or other medical professional) is required to see a public or private specialist (for either an outpatient consultation or admission to hospital), and so GPs act as gatekeepers of the health care system. Patients can present to the emergency department at a public hospital without a referral, and can also be admitted to hospital if necessary. A referral from a medical practitioner (or nurse practitioner in some cases) is required to access subsidised diagnostic tests, including laboratory tests and radiology, and a prescription is required to access prescription medicines. For most New Zealanders, public services are the default choice (and the only choice for emergency services and most hospital care). Patients are able to self-refer to many private services (e.g. allied health practitioners, dentists). There are referrals both ways between public and private sectors. There is sharing of personnel, especially medical specialists, many of whom work in both the public and private sectors, and professionals in both sectors have access to patient records. In general, GP and other referrals are confined to DHB boundaries, unless care (for example, highly specialized services) is not available locally. DHBs are monitored on how promptly they provide secondary services for their resident population and the referring DHB must reimburse the receiving DHB for care of patients outside their DHB area. Travel assistance is available for people who are referred long distances and/or frequently for specialist health or disability services. Referral policies are outlined in the MOH s Operational Policy Framework. Rongoā Māori Traditional Healing Rongoā Māori is informed by a body of knowledge that has as its core the enhancement of Māori wellbeing. In this way, Rongoā Māori differs from a Western medical paradigm, whose focus is principally the absence of health and wellbeing and the treatments/interventions required to return the patient to a state of health. Rongoā Māori traditional healing is formulated in a Māori cultural context, in which the understanding of events leading to ill health and its impacts are addressed through a range of culturally bounded responses. These culturally bounded responses include rākau rongoā (native flora herbal preparations), mirimiri (massage) and karakia (prayer). 2 In 2006, MoH of Health (MoH) published Ngā Taonga Tuku Iho: Treasures of our Heritage (2006), a rongoā development plan designed as a framework for strengthening the provision of quality rongoā services. The Ministry is also in the process of developing new Rongoā standards in consultation with the sector, as the existing standards published in 1999 require updating. The process will be led by the national rongoā body, Te Kāhui Rongoā, and will involve a comprehensive consultation and approval process with key stakeholders before the new standards are finalised. Quality The national Health Quality and Safety Commission (HQSC) leads and coordinates the health and disability sector for the purposes of determining and reporting indicators, and improving the quality and safety of health and disability support services. The Health and Disability Commissioner (HDC) ensures the rights of consumers are upheld, and health or disability service providers learn to improve their performance. All service providers have obligations under the Health and Disability Services (Safety) Act 2001, and there are a number of DHB accountability mechanisms under the NZPHD Act. 2 Ministry of Health Taonga Tuku Iho: Treasures of our Heritage: Rongoā Development Plan. Wellington: Ministry of Health. Health Service Delivery Profile, New Zealand

9 Equity Compared to many OECD countries New Zealand has a small and geographically dispersed population. New Zealand also has an increasing level of diversity, which means each region faces different patterns of demographic change. Although the national picture of health is positive, there are substantial variations in outcomes, particularly for Māori and Pacific peoples. For example: the rates of some illnesses such as rheumatic fever, and skin infections, are much higher among Māori and Pacific children between 2001 and 2010, the rate of ambulatory sensitive hospitalizations (ASH) increased by 6 percent for Māori and by 21 percent for Pacific peoples. At the same time, the rate decreased by 11 percent for other populations. 3 Lower incomes, poor educational outcomes, unemployment and social deprivation are higher in Māori and Pacific people than for other New Zealanders. The introduction of the child immunisation health target demonstrated that improvement for different population groups is possible when a uniform target intervention rate is set across all populations. DHBs needed to improve their efforts to reach Māori children as part of achieving the overall target. Twentyfour million dollars is being invested in access to rheumatic fever services, including school-based sore throat clinics, improving training for health workers and community workers, and support for research and monitoring. Many of the influences on people s health outcomes lie outside the direct ambit of the health and disability system. For example, the health of children is influenced by their household s living conditions, income and education levels. There are clear links between health and social issues, such as mental health, alcohol use and unemployment. The Ministry is increasingly working across government to address health and other priorities. There are now more than 150 service providers pursuing a Whānau Ora approach. A cross-government, integrated approach to the delivery of health and social services, Whānau Ora is designed to empower families to be self-managing and live healthy lifestyles, linking provider accountability to outcomes. Demands and constraints on the service delivery model There are a number of demands and constraints that are likely to impact upon future service delivery and design in New Zealand: Workforce shortages, particularly in rural and provincial areas, are a key threat to the health system s ability to provide a full range of accessible, high-quality health services, and both increasing the size of the workforce and implementing new ways of delivering services will be necessary to meet demand. Workforce limitations, population aging and chronic conditions have increased demand for primary care services, and some patients are finding it difficult to access some care. After hours primary care access is expensive in some areas. Some hospitals in regional cities and towns are having difficulty maintaining local 24/7 provision of acute care, due to static/declining regional populations and increasing sub-specialisation of the medical workforce. Some super-specialised tertiary services, and some specialist tertiary services in smaller cities, are threatened by low volumes and workforce shortages. In health promotion and disease prevention, there are a large number of small NGO providers, working with small population groups or niche groups (often with high health needs). There is concern about the viability of smaller providers, and the highly fragmented and variable nature of this system. 3 Ambulatory Sensitive Hospitalizations (ASH) are those that might have been avoided if health services had been delivered more effectively or if patients had accessed services provided in a community setting, including primary health care. Health Service Delivery Profile, New Zealand

10 There are financial and clinical viability issues in a number of residential care facilities, due to workforce scarcity, and the high costs associated with institutional care. The Statement of Intent is a public document that describes how MoH of Health will deliver its objectives and work to address the above challenges. This Statement of Intent sets out the work MoH will be undertaking in support of the Government s priorities and the measures by which we will know if we are on track. Specific policy development to support the objectives include: enabling patient self-care and more services to be delivered in the home setting; integrated services (Integrated, patient-centred care has been a strong focus over the year. The establishment of Integrated Family Health Centres ( one-stop shops ) are bringing a wider scope of services closer to home), including forming large community-based health centres, to increase access to community and specialist services; forming partnerships across DHB boundaries to improve financial viability and share resources; and consolidating some specialty services into a smaller number of centres. Indicators of progress Overall, the New Zealand health and disability system is performing well. Almost 90 percent of New Zealanders report that they are in good health. Life expectancy, a key measure of health status, continues to rise. In 2010, life expectancy at birth in New Zealand stood at 81.0 years, more than one year higher than the OECD average of 79.8 years (although Māori have a shorter life expectancy by 8 to 9 years). 4 This compares favourably with other OECD countries that achieve a similar life expectancy but spend more on health per capita (see Table 3.) The health and disability sector has achieved some impressive results over the last year. New Zealand has had the best result ever with respect to immunisations and has made further progress on smoking cessation, preventing cardiovascular disease, meeting the health targets (see Indicators of Progress section) and preventing rheumatic fever. The Ministry of Health has worked hard to support Canterbury as it recovers from the devastating earthquakes and will continue to support the rebuilding of the region s health sector, and its ability to make adjustments to respond to ongoing challenges. In accordance with Government policy, MoH has undertaken targeted work on system configuration. This has seen the creation of a range of new and reconstituted health sector bodies intended to drive improvement in key areas: the Health Quality and Safety Commission which was established to create a sharper focus on service quality and safety Health Benefits Ltd, which put in place shared services and joint procurement in order to release resources for frontline services new and refocused advisory committees to lead: workforce planning (Health Workforce New Zealand); IT investment (the IT Health Board); evaluation of technology investment options (the National Health Committee); capital investment decision-making (the Capital Investment Committee) and whole-of-system planning advice (the National Health Board) PHARMAC s role, which has expanded to get better value for money across pharmaceutical expenditure (including vaccines) and medical devices. The Government has committed to delivering a set of 10 Better Public Services results. The Better Public Services results were chosen for their importance in improving the lives of New Zealanders. In particular MoH of Health is working on result 3 - increasing infant immunisation rates and reducing the incidence of rheumatic fever. The Ministry of Health is also supporting other result areas including increasing participation in early childhood education and reducing assaults on children. The government s Health Targets are a set of six national performance measures specifically designed to improve the performance of health services and provide a focus for action in the areas of improving hospital productivity and speeding up the implementation of the Primary Health Care Strategy. They provide a way of measuring whether or not the health and disability system is delivering improvements in the health of New Zealanders and in their access to the services they need. The Minister identified six areas of focus for 2011/12: 4 OECD Health Data 2012: How Does New Zealand Compare Health Service Delivery Profile, New Zealand

11 shorter stays in emergency departments improved access to elective surgery shorter waits for cancer treatment increased immunisation better diabetes and cardiovascular services/more heart and diabetes checks better help for smokers to quit. The DHB reporting framework against the strategic and annual plans is a comprehensive national monitoring framework. The four dimensions of overall DHB performance as owners, funders and providers of services include: achieving government s priority goals/objectives and targets meeting service coverage requirements and supporting sector inter-connectedness purchasing the right mix and level of services within acceptable financial performance providing quality services efficiently. The entire scope of indicators, including logic, definitions, data sources, assessment criterion, and frequency of reporting etc., included in this framework is detailed in data dictionaries. There is currently an effort to move to more outcomes-based monitoring, although this is still in development. Regular national health surveys monitor health status and risk factors. New Zealanders overall trust and confidence in our health system has improved over recent years, according to Commonwealth Fund International Health Policy Surveys of adults aged 18 years and over. Nearly four in 10 (37 percent) New Zealanders surveyed in 2010 reported only minor changes are needed to our health system, up markedly from just under one in 10 (9 percent) in These figures compare well with other countries, with only United Kingdom respondents having a higher level of trust in their health system. Table 3. Comparison of health indicators in New Zealand with OECD Average Indicator New Zealand Year OECD average Total health spending as percentage of GDP 10.1% % 2010 Total health spending per capita 3022 USD USD 2010 Growth rate in health spending per capita 5.8% % Total health spending funded by public sources 83.2% % 2010 Practising physician per population Nurses per 1000 population Acute care hospital beds per population MRI units per population CT scanners per population Life expectancy 81 years years 2010 Prevalence of obesity among adults 27.8% % 2010 Proportion of adults smoking everyday 18.1% % 2010 Source: OECD Health Data 2012 Country Notes: How does New Zealand Compare Year Health Service Delivery Profile, New Zealand

12 References HealthCert. Certified Providers of Hospital and Rest Home Services. Available on: King, A. and Turia, T. He Korowai Oranga: Māori Health Strategy. Wellington, Ministry of Health, Available on: %20-%20Maori%20Health%20Strategy.pdf King, A. The New Zealand Health Strategy. Wellington, Ministry of Health, Available on: Ministry of Health, New Zealand. Briefing to the Incoming Minister of Health, December Wellington, Ministry of Health, Available on: Ministry of Health, New Zealand. DHB Non-financial monitoring framework & performance measures 2010/11 Overview. Ministry of Health, Available on: Ministry of Health, New Zealand. Nationwide Service Framework Library - General Information. Ministry of Health, Available on: Ministry of Health, New Zealand. Public Health Units. Ministry of Health, Available on: Ministry of Health, New Zealand. Statement of Intent Wellington, Ministry of Health, Available on: Ministry of Health, New Zealand. Structure of the health and disability sector. Wellington, Ministry of Health, Available on: Ministry of Health. 2010/2011 Service Coverage Schedule. Wellington, Ministry of Health, Available on: National Health Board. Trends in Service Design and New Models of Care: A Review. Wellington, Ministry of Health, Available on: Organization for Economic Cooperation and Development. OECD Health Data 2011: How does New Zealand Compare. OECD, Available on: Organization for Economic Cooperation and Development. OECD. StatExtracts. New Zealand: Country Statistical Profile. Available on: Sheridan NF, et al. Health equity in the New Zealand health care system: a national survey. International Journal for Equity in Health, 2011, 10:45. The Commonwealth Fund. International Profiles of Health Care Systems, Commonwealth Fund pub. no New York, The Commonwealth Fund, United Nations Development Programme. Sustainability and Equity: A Better Future for All. Human Development Report New York, UNDP, World Health Organization. Western Pacific Country Health Information Profiles (CHIPS): 2011 Revisions. Manila, WHO WPRO, References for Traditional Medicine Driscoll AA, Baker V, Hepi M and Hudson M. The future of Rongoa Maori: wellbeing and sustainability. Environmental Science and Research (ESR), Ministry of Health, Available on: Ministerial Advisory Committee on Complementary and Alternative Health. Regulation of CAM. Ministry of Health, Available on: Ministerial Advisory Committee on Complementary and Alternative Health. Complementary and Alternative Medicine Current Policies and Policy Issues in New Zealand and Selected Countries: A Discussion Report. Wellington, Ministry of Health, St. George, D. Overview of MoH s Integrative Health Care Initiative. Wellington, Ministry of Health, Wilson K, Dowson C and Mangin D. Prevalence of complementary and alternative medicine use in Christchurch, New Zealand: children attending general practice versus pediatric outpatients. Journal of the New Zealand Medical Association, 2007, Vol. 120 NO World Health Organization. Regional strategy for Traditional Medicine in the Western Pacific ( ). Manila, WHO WPRO, Available on: World Health Organization. The Second WHO Global Survey on National Policy and Regulation for Traditional and Complementary/ Alternative Medicine. WHO, 2011 (Draft). i Health Service Delivery Profile, New Zealand