Content area
Full Text
At face value, Aotearoa's health system seems to provide "cradle to the grave" universal healthcare to all New Zealand-ers, with the aim of allowing individuals to lead healthy and fulfilling lives. By population metrics, Aotearoa seems to do well with an overall life expectancy of 83 years, with annual increase of Q.18%.1 On the global happiness index, of which health contributes a significant component, Aotearoa is ranked within the top ten countries in the world.2
The Aotearoa health system is facing increasing pressures due to unprecedented demand. In secondary care, active decisions to ration infrastructure investment, workforce training and budget spend have been made. Yet no coordinated approach to explicitly ration acute secondary care demand to match available resources has been implemented. The workforce would appear to be at breaking point. We must consider some important principles, issues and barriers if explicit rationing were to be implemented in a just and fair way.
Aotearoa's health system is required to operate within the principles of several important legal documents, including: Te Tiriti o Waitangi3, article 25 of Universal Declaration of Human Rights (1948),4 Right 8 of the New Zealand Bill of Rights Act (1990),5 the New Zealand Public Health and Disability Act (2000)6 and the Code of Health and Disability Services Consumers' Rights 7. Importantly, these state that all people have rights to good health and access to necessary resources,47 and that no one individual should be deprived of life unlawfully or inconsistently with principles of fundamental justice .5 Such principles are to be pursued to the extent that they are reasonably achievable within the funding provided.67 District health boards (DHBs) are expected to operate in a financially responsible manner and endeavour to cover all annual costs.6 In addition, each DHB is required to be a good employer, which includes providing a good and safe working environment for its staff.6 However, there is no mention in these documents on the process or principles to apply should underlying resources not be able to meet the previously stated requirements. Although the concept of fundamental justice is incorporated in the New Zealand Bill of Rights,5 a clear and concise definition remains elusive.
Secondary care health services within Aotearoa would seem to be in crisis. The collective draft deficit of...