Improving health and well-being and promoting equity in outcomes are long-standing goals of New Zealand governments (for example, Department of Health, 1989; King, 2000; Ryall, 2007; Ministry of Health, 2016a, 2016b).1 New Zealand’s publicly funded health system delivers millions of high-quality services each year to achieve these goals. Our level of expenditure per capita on health care is slightly below the OECD average, but our health care system provides good overall health outcomes for the money we spend (OECD, 2015). Both our life expectancy and health expectancy (the years we live in good health) are increasing, although the former is increasing faster than the latter, leading to an increase in the number of years New Zealanders spend in poorer health; a key challenge is to improve our quality of life as people age (Ministry of Health, 2017a). Sadly, however, there are significant inequities in health, with Mäori, Pasifika and lower-income people having poorer health than other New Zealanders (Ministry of Health, 2017a).
Health policy is one of the most challenging for any government. Many more health needs could be met with new funding; indeed, the demand for health care is virtually insatiable. There are significant inequities in health to ameliorate. There are workforce shortages and salary inequities to overcome. There are demands for new technologies. And there are rising demands for services arising from ageing populations and a growing burden from long-term conditions. These factors pressure governments every day to spend more.
This article explores some key questions to ask of potential future governments in relation to health policy in New Zealand. First, I look at issues relating to the health of New Zealanders. Second, I discuss recent health expenditure trends. Third, I turn to focus on how we are doing with respect to primary health care, an area that has been at the forefront of New Zealand health policy debate in recent years. Finally, I draw some overall conclusions.