8 JULY NEW ZEALAND GAZETTE 1953

(d) Recognise the importance of public health initiatives; and

(e) Encourage co-operation between the Public Health Commission and the RHAs in the purchase of services promoting the public health, particularly in relation to immunisation and the prevention of:

• cot death;
• melanoma;
• child hearing loss;
• tobacco smoking in pregnancy; and
• cervical cancer.

Part II: Objectives for the Financial Year to 30 June 1994

(i) The Crown’s objectives for the financial year to 30 June 1994 (the “Funding Period”) have been developed across areas that deal with the health status of people who are eligible for health and disability services purchased or to be purchased by the Midland Regional Health Authority (“Eligible People”), the health and disability services purchased or to be purchased by Eligible People to those services, the standards of those services, and the special needs of Maori and other communities or people in the region for which the Midland Regional Health Authority is responsible.

(ii) The Crown’s objectives for the Funding Period are:

Health Status

(a) That, as far as possible having regard to the transitional year, the particular socio-economic and demographic characteristics of the region for which the Midland Regional Health Authority is responsible, and related health status concerns, are taken into account in the purchase of health and disability services for Eligible People.

The following items are to be noted in relation to this objective:

The socio-economic and demographic characteristics of the region for which the Midland Regional Health Authority is responsible are:

(i) A population in which there is a higher than average proportion of infants and children aged 0-14, with one third of all infants and children aged 0-14 being Maori;

(ii) A variation in the dispersion of communities, ranging from Ruapehu with a population density of 2.5 persons per square kilometre, to Hamilton with a population density of over 1000 persons per square kilometre;

(iii) A Maori population comprising 21% of the population (compared with 12.8% of New Zealand’s total population). There is a significant variation in the proportion of the population who are Maori, ranging from Tirauwhiti where 40% of the population is Maori, to Taranaki where 12% is Maori; and

(iv) An overall low proportion of Pacific Island communities.

Some of the major concerns about health status and health and disability services for the Midland Regional Health Authority are:

(i) Significant demands on pregnancy and childbirth services, and issues surrounding infant mortality;

(ii) A need to develop appropriate continuing care and disability support services targeted at areas with large older adult populations;

(iii) A need to address the particular health status needs of a proportionately high number of lower income households in the region for which the Midland Regional Health Authority is responsible; and

(iv) A need to address the particular health status and needs for services, of Maori.

Health and Disability Services to be Purchased

(b) That, in general, the Midland Regional Health Authority purchase those health and disability services to which Eligible People had access funded from Crown Vote: Health or (in certain specified instances) Crown Vote: Social Welfare in 1992/1993, including services in respect of accidents.

(c) Wherever possible, given the transitional year, that the Midland Regional Health Authority recognise the following priorities for changes in service provision:

(i) Improved provision of comprehensive co-ordinated therapeutic mental health (including substance abuse) services ranging from primary to inpatient services;

(ii) Improved “well child care” services including parenting skills development, “well child” screening, immunisation, prevention of hearing loss, and prevention of injury to under five year olds;

(iii) Greater emphasis on community support and on providing appropriate support services in the community to enable independence;

(iv) Provision for a more comprehensive and co-ordinated range of services to address the special needs of Maori;

(v) Improved access to assessment and rehabilitation and disability services; and

(vi) Appropriately managed deinstitutionalisation.

Terms of Access to Services

(d) In general, to maintain existing terms of access to services for Eligible People.

The following items are to be noted in relation to this objective:

Crown May Set User Charges

In cases where the Crown or the Midland Regional Health Authority stipulates the total fee payable to a provider for a service, the Crown will in general place limits on the amount of that fee payable by the service user (the user charge). There will continue to be some exemptions from user charges. In other cases, the Crown may specify the minimum amount to be paid by the Midland Regional Health Authority.

Enrolment Systems

The Midland Regional Health Authority and some providers of health and disability services may wish to enter purchase arrangements which require a particular provider to establish a practice register. It is not anticipated that a full practice enrolment system could be agreed between the Midland Regional Health Authority and primary care providers in the transitional year. Such a system would raise issues on which the Crown and the Accident Rehabilitation and Compensation Insurance Corporation need to be consulted before it is developed.

Forensic Psychiatric Services

In order to secure the best forensic psychiatric services, the national network of six multi-disciplinary regional forensic teams, seven regional medium secure units, a national maximum security facility and appropriate rehabilitation facilities must be used.

Cervical Screening

The national cervical screening programme and register services will continue with national co-ordination provided by the Ministry of Health.

Blood Transfusion Services

It is important to provide a high quality blood transfusion service, which continues to recognise that the donation of blood is critical to the service, and is an important contribution individuals can make towards the welfare of fellow New Zealanders. The “gift” status of donated blood is to be preserved.