1. Primary Health- low fees are good but what’s next Speech to Dunedin School of Medicine 21 July 2006

2. Fees for 45- 64 year olds by DHB before and after 1 July

3. Net profit per GP practice owner after Waikato University Business Survey

4. The Commonwealth Fund: Mirror Mirror…

5. Going without needed care due to costs, total and low income AUS CAN NZ UK US

6. Percentage foregoing a GP visit because of cost New Zealand Health Survey 2002

7. Quotes from two mothers

8. The burden - key facts Chronic disease accounts for 70% of all deaths Chronic disease increases with age Diabetes in people 65 – 74 years is 12 times that of people <45 years Every decade the number of people > 65 years with chronic conditions doubles 30% of NZ children are overweight or obese

9. Standardised mortality rates for diabetes by ethnicity, 1996-98 0 10 20 30 40 50 60 199619971998 SMR per 100,000 population Maori Pacific peoples European/Other

10. Access by Maori to CABG

11. The platforms of the Primary Health Care Strategy Population-based approach Outreach to patients with little or no previous contact with primary health Health Promotion Lower fees Performance Management to reward good primary health practice Greater use of the primary health team of professionals The patient as an expert

12. Growth of PHO enrollment 94% of NZers enrolled in 81 PHOs

13. An evolution in who ‘owns’ the PHCS 20022006…. Minister Ministry DHBS PHOs Communities COMMUNITIES to GP unseen by a specialist (Maybe) 25% referrals to specialist can be ‘handled

14. What we know Because good Primary Health Care is known to reduce health inequalities a good Government should especially value the provision of good Primary Health Care to populations where disparities are known to be high

15. The role of a GP? Dr R works in a private practice. She begins her 20- minute visit with Mr H by: Thumbing through a chart with his latest Haemoglobin A, LDH/HDH cholesterol, eye exam, and prostate specific antigen test results She then spends 5 minutes comparing medication brought by Mr H with a chronic medication list She leaves the room to request influenza and pneumonia immunisations from an assistant She learns Mr H has been unable to secure an appointment with a urologist for a prostate biopsy promises to phone and do it herself As Mr H leaves she realises she did not need a medical degree to do any of the tasks she performed during the visit 2004 American Medical Association

16. Endless reform…can look like this

18. Improves population health Reduces inequalities Reduces health costs Primary health care, because it Improves population health –Reduces all cause mortality, –Reduces heart disease, stroke, cancer mortality –Reduces low birth weight –And improves self-rated health Reduces inequalities Reduces health costs Starfield, B., Shi, L., Macinko, J. 2005. The Milbank Quarterly Vol 83; Number 3