New Zealanders expect and deserve safe health care of the highest quality. We have a complex health care system that helps prevent and treat illness every day, and provides care to those reaching the end of their life.
This report looks at currently available measures within a framework for understanding quality and considers ‘How good is New Zealand’s health care?’ It seeks to create debate around the meaning and interpretation of the data presented, with a view to stimulating initiatives to improve our health and disability services.
Five specific questions are explored.
- When our patients most need to be safe, are they?
- Is the experience of patients being cared for in our system good?
- Is care effective, with the right care providing good outcomes?
- Do we provide an equitable system with good health care for all, regardless of sex, ethnicity, age or income?
- Does our system provide good value for money – does it avoid waste and deliver good outcomes for the resources used?
Key Results
The evidence in this report indicates New Zealand’s health and disability system is as good as, or better than, the health systems in most other similar developed countries for 7 out of the 10 measures where robust international comparison is possible. Most of the measures are improving or maintaining their position. A high proportion of patients report they were treated with dignity, respect, kindness and compassion in our hospitals. International comparisons show our health care system provides good value for money and helps people live longer, healthier lives.
Specifically:
• Disability adjusted life years lost (DALYs) per 100,000 population in New Zealand is seventh lowest of those OECD nations measured by the World Health Organization (WHO) – similar to Australia and lower than most western European countries, the US and Canada. This shows our health system is effective in helping people live longer, healthier lives.
• Early results from a new national patient experience survey for inpatients show positive results compared with jurisdictions such as England, Sweden and Canada. Patients generally have a good experience in hospital, and feel they are treated with dignity, respect, kindness and compassion.
• The system has addressed inequity in some targeted areas – notably immunisation, in which large disparities between Māori and non-Māori child vaccination rates have been almost eliminated in five years.
• Our health system is relatively inexpensive compared with similar countries – New Zealand is the 18th highest of 34 OECD countries in per capita expenditure on health care. Less is spent than in nearly all comparable English-speaking and northern European countries. This, combined with results similar to or better than these countries for most quality measures, suggests a system which provides good value for money.
• Specific process measures have improved over the past three years. For example:
– the use of insertion bundles to prevent central line associated bacteraemia (CLAB) is now routine in intensive care units (ICUs), and generally in other settings as well. This is comparable with the State of Michigan and better than most other countries
– New Zealand’s compliance with best practice hand hygiene requirements has increased from 62 percent in 2012 to 77 percent in 2015. This is similar to recent data for Australia and Canada.
• Outcomes are more variable:
– The rate of CLAB infection in ICUs has fallen from 3.3 per 1000 line days in 2011 to 0.37 in 2014 and is now very rare. New Zealand performs well internationally on this measure.
– Rates of Staphylococcus aureus bacteraemia (a common bacterial infection in hospitals) have not changed. New Zealand’s rates are slightly higher than Australia’s and lower than Scotland’s.
– There has been an increase in postoperative sepsis in recent years. The cause is unclear and further work is needed to understand and address this increase. New Zealand does not compare well with other countries in this measure.
There are three clear areas for improvement:
• Inequity in access. New Zealanders report economic barriers in access to health care second only to the US. This data precedes recent initiatives to provide free access to general practitioners (GPs) for children aged under 13. However, the Atlas of Healthcare Variation provides several other examples of variation between ethnic groups in use of the most appropriate care.
• Harm to patients – as illustrated by the Commission’s annual report of serious adverse events.4
• Variation in patterns of care, even when taking into account the different needs of populations, or the wishes of individual patients.