The promise of free prescriptions and GP visits for pre-teens next year is being cautiously welcomed by the health sector but other sectors have leaner pickings.
From July next year $30 million a year is being put aside to extend free primary health care from under-five-year olds to include children up to under-13. Though question marks are already being raised over whether the introduction would be smoother than bringing in free fees for the under-sixes and whether the funding would be enough to make it viable.
Vote Health also includes new funding for Youth One Stop Shops which are to get nearly $1.2 million in 2014-15 but stepping up to $2.35 million a year to a total of $8.6 million over four years.
But the elderly and residential aged care got lean pickings with an extra $10 million a year for four years to fund “additional support for elderly people”, including people with dementia, with details of how the funding is to be spent still to be announced.
In all public health expenditure for 2014 is up to a record $15.6 billion of which $348 million is new funding to cover cost pressures and population increases and new policy initiatives. (Plus $73.5 million of ‘reprioritised’ savings from health services funding).
The majority of that extra funding – about $275 million - is again earmarked to meet the increased costs to district health boards caused by inflation and population demands though the Council of Trade Unions and health unions have said this fell short of what was required to maintain the status quo in public hospital services.
A sizable amount of funding this year also went this year to disability services (an additional $28.8 million a year to meet cost and volume pressures plus $5.6 million for other initiatives and $24 million a year for home-based support) while aged care was largely left out in the cold.
New Zealand Aged Care Association has estimated the aged residential care sector needs an increase of 7.6 percent, or $76 million, to even allow it to maintain the status quo.
Dr Jill Clendon, policy analyst for the New Zealand Nurses Organisation highlighted that there was nothing in the Budget to address pay equity issues in the aged care sector.
Martin Taylor, NZACA chief executive, said the changes to KiwiSaver contributions, the minimum wage increase, inflationary increases, and insurance premium increases have all led to increased costs in the delivery of aged residential care.
Other extra spending includes $25 million a year extra for elective surgery, $2.5 million for bariatric surgery, $1 million for upping kidney transplant numbers and a one-off $8 million this year to reduce waiting lists for colonoscopies.
Cancer treatment initiatives are to get an extra $1.2 million this year and will step up to $5-6 million a year in 2015-16 including 20 cancer support workers and six cancer centres with a specialist psychologist each.
Primary health got $2.5 million extra a year for rural general practices and $3.3 million towards subsidising low cost doctors visits.
But it looks that the new graduate nurse scholarships for nurses working in very low cost access (VCLA) practice are to be a one-off with $1.5 million allocated for the 2014-2015 year but no funding beyond that.
Mental health also was not a big winner with the only new initiative being an extra $500,000 funding a year for mental health district inspectors to “monitor and protect’ consumer interests.
The Budget also had extra funding for postgraduate education and training of doctors ($17.8 million over four years) and for 34 new medical school places a year. No specific mention was made of nursing training.
Clendon said overall NZNO saw Budget 2014 as a “budget of crumbs” which provided very little for Maori health services or “dealing with stagnant wages, growing food and interest rate costs which result in more inequality and poverty in our communities.”
She said nurses were also disappointed that Budget 2014 had failed to deliver the increase in DHB funding required to even maintain current service levels. The Council for Trade Unions has estimated that to meet population demands DHBs would need an extra $399 million to maintain the status quo. “More cuts and increased pressure on nurses will be the result, with the inevitable flow on affect of compromised patient care,” she said.
Clendon said NZNO strongly supported the extension of free GP visits and prescriptions to children under 13 and hoped the scheme would be “workable”.
“Free health care for under 6s took several years to implement with the level of funding insufficient for many general practices to be interested in the programme,” said Clendon. “We hope this won’t happen again.”
This was echoed by the chair of the Rural General Practice Network, Dr Jo Scott-Jones, who said the free care for under-6s had been provided at the expense of reduced incomes for practice owners.
“And how the $90 million to make GP visits and prescriptions free for children aged under 13 from July 1, 2015 will be managed will be extremely interesting to watch. A free at the point of care service is very attractive and laudable, one which we would in principle support, but it has to be done in a way that is affordable.”
Dr Mark Peterson, chair of the New Zealand Medical Association expressed similar concerns to Radio New Zealand and said he would be interested to see whether the subsidy increase to general practices matched the reduction in income from lost co-payments from 6-12 year olds