Patient Voice Aotearoa chair Malcolm Mulholland. Photo: RNZ / Jimmy Ellingham
For some cancer patients, the Budget could literally be a matter of life-or-death.
Patient Voice Aotearoa chair Malcolm Mulholland will lead a delegation of blood cancer patients to Parliament on Thursday to see if the Budget will deliver on the government's promise they "won't be forgotten".
The backlash after last year's Budget failed to include funding for National's pre-election promise of extra cancer treatments forced the gvernment a couple of months later to produce another $604m for Pharmac over four years.
That welcome investment allowed Pharmac to fund a range of drugs for patients with solid tumours - but increased inequities for blood cancer patients, Mulholland said.
"Blood cancer patients haven't had anything. If we look at just multiple myeloma for example, 450 people are diagnosed every year, but there's been no new drug funded since 2014. That to me is criminal."
While the previous Health Minister Dr Shane Reti had given his assurances that blood cancer patients "would not be forgotten", his replacement, Simeon Brown, has made no commitments.
GPs banking on Budget boost
Brown's only pre-Budget announcement has been an extra $164m for after-hours GPs and urgent care in targeted regions.
While welcoming the support, GP leaders noted primary care in general needed a massive cash injection.
A Health NZ briefing to Dr Reti in January 2024, projected a $173m shortfall in funding to GPs for the year, and estimated primary care needed a boost of between $353m and $1.4b to address "unmet need".
General Practice NZ chair Bryan Betty said the capitation funding model - the way the government funds general practices based on the number and age of enrolled patients - was 20 years old and "no longer fit for purpose".
"General practice is faced with a lot more complexity in terms of patients, patients who are not being seen in the hospital and they're expecting general practice to pick up and deal with, and also the volume of what we're actually seeing."
General Practice NZ chair Bryan Betty. Photo: Supplied
Dr Betty, a family doctor in Porirua, said the last capitation uplift was not enough to cover inflation, so the government allowed GPs to raise their fees.
"There is concern about the amount of money people are paying to see their GP now, so I think we have to avoid shifting cost to patients."
Hospital services need $2b extra 'just to stand still' - senior doctors' union
However, the Association of Salaried Medical Specialists, which represents senior hospital doctors and dentists, said there was not a single area of health, which was not "desperate" for more money.
Its director of policy and research, Harriet Wild, said there was little point pumping more money into primary care without balancing it up with more investment in secondary services.
"For example, if you're going to invest in primary care, but you're not going to invest in secondary and hospital care, you're going to get more people needing and gaining hospital referrals to have their conditions managed and treated. But if there isn't a complementary investment in secondary care, there's not going to be anyone to manage them."
With every health budget, it was "not so much where the money is going - it's where it's coming from", she noted.
"It's all about savings, it's all about ending time-limited funding. Re-appropriating is the name of the game. And I think we'll continue to see more of that in 2025."
Last year's Budget included an extra $16b over four years to meet cost pressures.
However, Wild said that was not enough.
Analysis by leading health economist Peter Huskinson found day-to-day government spend per person on health actually dropped 3 percent last year.
"We are estimating that Budget 2025 is going to need an extra $2b in operational funding, just to stand still," Wild said.
"Our members are constantly being asked to do more with less, and then they're asked to do more again."
Stop making health a political 'game'
Health systems expert Professor Robin Gauld - who moved from Otago to Bond University in Australia this year - said there was never enough money for health.
Health systems expert Professor Robin Gauld. Photo: RNZ / Ian Telfer
"And [what] governments will always claim is big new investments, which there probably is - but it will be dealing with shortfalls and inflation adjustments and targeted to certain areas."
Instead of just shovelling more money into a broken system, the government needed to fund research to re-design it, Professor Gauld said.
He has proposed a national health insurance model like Singapore's (which works a bit like ACC), which would take the health budget out of the hands of politicians.
"In Singapore, they're working really hard to solve problems with a long-range view. It's not a political bun-fight or a game like it is in New Zealand.
"Here's it's a political game for people who then walk away and go on to other jobs, having said that they did 'a great job'.
"They blame their successors, and their successors blame the forebears, instead of all working together in a Singaporean way to try and actually improve population health and the system that supports it."
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