U.S.-style health care option proposed by team

Press, 5 December 1986, Page 3

U.S.-style health care option proposed by team

PA Wellington The introduction of American-style “health maintenance organisations” was one of a number of options proposed yesterday by a team reviewing health benefits. The review team also suggested, among a range of choices, that the Government should contract more health care to others.

Its “Choices for Health Care” report said ideas which were part of the welfare State for nearly 50 years could no longer be taken for granted. In spite of good intentions, the basic idea behind the Social Security Act, 1938, of a fair distribution of health care to all, may not have been realised, the report said.

The report put forward five broad options as suggestions for the Government’s consideration.

They were: ® Modifying the present system, with the Government providing the major cost of health services, but replacing pre-

sent differing subsidies with uniform rates. ® Reducing the role of the Government as a health funder to that of a “residual insurer” providing a safety net for highrisk and low-income groups, and perhaps imposing compulsory health insurance for others. @ Setting up health maintenance organisations (H.M.O.s). 0 Retaining the Government as the main funder of health care but having a mix of services provided by the Government and by others, such as area health boards. © Having the State assume a near-monopoly by employing doctors and other primary care workers on salaries, as well as providing secondary services such as hospitals. The concept of H.M.O.s, the report said, could parallel the organisations established in the United States, which employed their own doctors.

Subscribers paid an annual fee to enrol and in return received the prim-

ary and secondary care they needed for each year.

The report said a system of privately-run and competitive H.M.O.S might have potential in the long term, but would have to be run in a framework which prohibited the organisations "shedding” high-risk people. It added, however, that the idea was far too removed from New Zealand’s present system to. be implemented quickly, although it deserved further consideration. The Minister of Health, Dr Bassett, said the Government had at present no "expressed preference” for any of the five options outlined. “The report is a discussion document, no more, no less,” he said. But the review team said that from “the point of view of efficiency as well as equity” it favoured moving either to a system of competitive H.M.O.s or, with the Government as main funder, contracting out at least some services.