Inequity in access to medical care was seen as one of the most critical problems in the health system, Prof Miriam Wiley of the Economic and Social Research Institute said yesterday.
She told a health strategy forum she hoped there could be one health system for all. The forum was the first plenary session in consultations to prepare a new national health strategy.
Prof Wiley said a previous health plan for 1994 to 1997 was innovative for its time. From discussions the ESRI had had with all interested parties recently it was clear a lot needed to be done on the new strategy. She said there was a "perception that equity is an even bigger problem in the current health system compared to the early- to mid-1990s".
There was consensus that equity was a major problem and certainly they saw concrete evidence of that in more people buying health insurance and the increased waiting lists.
"Equity isn't an easy issue to address and it is perceived at lots of different levels, the geographical issue, the access issue, the financial issue and so on. I don't think there is anybody who could deny it remains one of the most critical problems to be addressed," she said.
Expectations were higher now. People expected to receive equal medical services no matter where they lived. Waiting lists, for instance, varied in different health board areas.
"People are very concerned that access should be on the basis of medical need and not where they live," she said.
One respondent who was closely involved with the 1994 strategy had told her his aim was to have one health system instead of eight in the health board areas - but now they were looking at 10 health systems.
Prof Wiley said in terms of quality of care people suggested they had not seen the sort of progress they had hoped for over the past few years.
Clinical accountability was again an area that had not been advanced at the pace desired and anticipated. They had seen substantial progress in financial accountability and this had an effect on the operation of the system but it was just a starting point.
In 1994 there was a disease based approach in planning and it chose areas responsible for premature mortality. They had seen the development since then of cardiovascular and cancer strategies. There was much less concern about accidents, which had not received anything like the investment and commitment of the other two areas, she said.
Where did they go from here, she asked. It was important that communication worked well, that there was a clear implementation plan and that priorities were made clear.
Prof Wiley said the new health system must make accommodation for unforeseen events. For instance, in 1994 they could not have foreseen the problems such as manpower, and the safety of blood products and food.