The challenges of long-range planning for healthcare funding, performance and outcomes

There can be no denying that our health system has failed multiple populations on multiple accounts over the years in terms of delivering on the original goals of the Social Security Act.1,5,6 If it had not, access to care would be equitable, and so would outcomes. Similar could be said of macroeconomic performance-there would be close links between macroeconomic activity and the healthcare system with a strong population-health focus and active interlinking between the activities of different arms of government and the various public and social services. There would be considerably more focus on planning, including for workforce needs, but also in terms of ironing-out longstanding inadequacies in the funding model for health.7 Such issues have, again, been highlighted in the 2020 Health and Disability System Review.8 The Minister of Health has suggested that implementation of this review will focus on some key areas, such as, importantly, developing a Maori Health Authority-some three decades after the idea was originalfy floated as part of the ill-fated 'health reforms' of the early-1990s.9 Implementation will also focus on supporting people to stay well in the community; high-quality emergency and specialist care when it is needed; digital services and technology to provide more care in communities; and valuing and training a sufficient healthcare workforce. Yet the user-pay element of the system would not exist without considerable public sector support and backing, which includes picking up the costs of patients who have had complications following private treatment and then need to be cared for in the public sector-paid for, of course, by the majority of taxpayers who cannot afford to access the private sector they are supporting.10 This issue has sat outside of policy conversations over the years, possibly because it is in the too-hard basket and too provocative to raise.