The Ministers proposals:

Ruapehu Bulletin, Volume 9, Issue 409, 22 October 1991, Page 9

The Ministers proposals:

The following is a summary of "Your Health and the Public Health", a statement on Government health policy by Minister of Health Simon Upton: A new structure for the provision of publicly funded health care services will be introduced to: • Improve access for

all New Zealanders to a health care system that is effective, fair and affordable. • Encourage efficiency, flexibility and innovation in the delivery of health care to the community. • Reduce waiting times for hospital operations. • Widen the choice

of hospitals and health care services for consumers. • Enhance the working environment for health professionals. • Increase the sensitivity of the health care system to the changing needs of people in our society. Commissioners will be appointed to take

over existing health board functions as a first step towards the introduction of a new structure for the administration of publicly-funded health services. The purchasing and provision roles currently performed by area health boards will be separated. Four Regional Health Authorities (RHAs) will be established to manage the purchasing of, and contracting for, health services throughout New Zealand. The RHAs will take over responsibility for funding both primary care, provided by general practitioners and others in the community, and hospital based care. Unlike area health boards, the RHAs will not own any hospitals or other facilities, so they will feel no obligation to concentrate funding on their own hospital based services. The RHAs will purchase services either from the public, private or voluntary sectors. Most big public hospitals will be established on more businesslike lines as Crown Health Enterprises (CHE&) with appointed boards of directors drawing on business as well as health sector expertise. A Minister of Crown Health Enterprises will be appointed to represent the Crown's interest as the owner of public hospitals and associated services. Many smaller communities will be given the opportunity to take over their local hospitals and run them as trusts. People will be given the choice of obtaining their health care through RHAs or through other (non-Government) health care plans. The Government will explicitly define the core health services for which Government assistance is available. The Government will appoint a National Advisory Committee on Core Health Services to establish a process of public consultation about core health services. The current system of user part-charges will be rationalised. User part-charges will be extended to some aspects of hospital services and outpatient visits to specialists for people on middle and upper incomes. Service currently provided by area health boards will continue to be free of charge to beneficiaries and people on Turnpage 11

The Minister's proposals

FrompagelO low incomes. Accident compensation levies have been adjusted to cover more of the costs of health care for work-related accidents and motor vehicle accidents. The public and health professionals will be consulted on how the changes should be implemented. A system for managing the transition to the new structure has been designed. Public comment will be sought before major decisions are made to determine: • How we should determine the limits to core health services - the

services for which Government assistance is available. • The option to be adopted for funding health services - from taxes as at present, or from a new system of health premiums, replacing taxes. A new, separate system for the promotion and protection of public health through activities such as the monitoring of hygiene standards and publicity campaigns promoting health lifestyles will be established. A timetable for the implementation of all key decisions by the 1993/94 financial year has been established.