Political Challenges to the New Zealand Primary Health Care Strategy
The underlying political question here is why are PHOs separate to the DHBs? Much of this can be answered by thinking about the political challenges provision of primary health care entails. the table below identifies the political challenges faced and explains the effect they have on primary care.
Political challenges of the NZPHCS and the effect they have.
| Challenge |
Effect |
| Funding |
- No available funding for administration, management and compliance costs (Ashton 2003).
- Smaller providers disadvantaged by these costs, who are more likely to be those providing alternative types of care (Ashton and Cumming 2004).
- Potential for PHO market to exist, where patients swap between providers without providers being willing to share patient information (Ashton and Cumming 2004).
|
| Accountability |
- PHO accountability measures of PHOs to community are questionable (Howell 2006).
- Boards have weaknesses in business planning, research, community liaison, protocol development and referred service management (Centre for Health Services Research and Policy 2005).
|
| DHB/Ministry relations |
- Concerns about DHBs ability to provide effective primary care, given their stake in hospital sector (Ashton 2003).
- Ministry finds managing PHOs difficult due to contract relationships (Ashton and Cumming 2004).
|
| Provider concerns |
- Mixed benefits of PHOs for varying providers (Centre for Health Services Research and Policy 2005).
- Concerns about PHOs competing for high needs patients in order to retain highest levels of funding (Ministry of Health 2000).
|
| Provider capture |
- GP dominated sector where those in collective groups before set up of PHOs do much better (Ashton and Cumming 2004).
- Concern over rent seeking behaviour, where GPs have monopoly on primary care provision (Howell 2006).
|
