Can the health system deliver parties' election promises?

Hot on the heels of a hard-hitting flu season, healthcare has become one of the major election issues. As 7 November approaches, the parties are offering cheaper access, more medicines and new services - but can the health system actually deliver them? Health correspondent Kate Green reports.Free visits to the doctor? Free dental care? Or a brand new cancer treatment centre?Political parties have put forward a raft of ideas to improve the state of the system, from free care to funding boosts to new taxes ringfenced for health.See a list of every political party's election policies on health here.But according to Professor Frank Frizelle ONZM, surgeon and editor-in-chief of the New Zealand Medical Journal, policies and outcomes are not the same thing.Free GP consultations would still require GPs, just as lowering the bowel screening age would require enough colonoscopy, pathology and treatment capacity, while funding more cancer drugs would require oncology capacity, he said.He compared this year's election promises to patching holes rather than addressing the underlying problem."Everyone's thinking very short term with health and it's very hard to see how continuing to do minor adjustments is going to change the fundamental issue we have, which is that we've got an ageing population."Professor Frank Frizelle.Michael BradleyHealth targets here to stayThe government's most recent health target results show the postcode lottery remains a barrier to care. Nationally, all five targets had improved on the year before, but in the Northland and Southern districts, more than 40 percent of patients were waiting longer than the target of four months for elective treatments.Compared with the previous quarter, emergency department wait times improved in half of the country's health districts, while the other half went backwards.Labour has said it would keep coalition government's health targets if elected.Focus on primary care and early detectionLabour has promised three free doctor's appointments a year, funded by its new capital gains tax, as well as free prescriptions, maternity scans and cervical screening.ACT has promised a $400 million funding boost aimed at retaining more GPs in New Zealand and attracting more from overseas.The Greens want to provide free dental care.NZ First is promising to focus on prevention by embedding good nutrition into the school curriculum, focusing on metabolic health to prevent chronic illness, funding research into how nutrition can prevent or treat mental illness and investing in hospital trials of how effective intravenous vitamin C pre- and post-surgery is for treating infection.And Opportunity wants to work across the aisle to establish a 10-year health plan, increase health spending from the current 7.4 percent of GDP to 9 percent, and increase the proportion going to primary care.David Marshall, national president of Grey Power, said access to primary care was important for seniors."If people are seen early, you prevent deterioration and getting into hospital and clogging up the system and poorer outcomes," he said.While some Grey Power members didn't believe they needed free GP visits, Marshall said cost was a real barrier for others. Delaying treatment could mean their condition worsened, eventually requiring hospital care and adding to pressure there.But he raised the same question as Frizelle: "Do we have the GPs available to service that?"He also wanted more commitment from parties to supporting aged care."We really don't want older people having to be in hospital, which once again is very expensive," Marshall said. "It would be far better that they could be cared for in home or in residential care. But of course, there's not enough beds at the moment."Malcolm Mulholland, chair of Patient Voice Aotearoa, said the Greens' dental policy could help a large number of people and argued it could save the country millions of dollars.A dentist in Timaru had told him he was performing a huge number of teeth extractions, and characterised the state of children's dental care as "a total disintegration of services".Medicines and cancer careThe National Party wants to redirect foreign aid money into funding for new medicines, and would continue to pursue its health targets.ACT wants to build New Zealand's first dedicated national cancer centre, as well as allowing pharmacists to treat and manage more conditions.The National-led government has already boosted Pharmac's budget and funded a series of new cancer drugs.Patient Voice Aotearoa chair Malcolm Mulholland.RNZ / Baz MacdonaldBut Mulholland described the increase as a "sugar hit"."[The improvements] won't be obvious to the public, but they certainly will be by the end of next year, I would expect."The bit that we need the politicians to focus on is what they're responsible for, and that is the budget that Pharmac receives," he said. "Give us a plan by which we can catch up with the rest of the world, a plan that preferably would have multi-partisan support."Frizelle said no matter who people normally voted for, health was a "significant issue" this election."And whether you're 30 and indestructible or 70 and quite frail, health will eventually affect all of us."