Reti Shane: SuperGold Health Check Bill — First ReadingText is incorporated into the Bound VolumeReti Shane: SuperGold Health Check Bill — First Reading[Sitting date: 24 June 2015. Volume:706;Page:4757. Text is incorporated into the Bound Volume.]Dr SHANE RETI (National—Whangarei): It is a pleasure to speak on this bill. We support the intention of improved access to health care for older people but this bill is not the right tool to do that. It suffers from a lack of understanding of how medical services are provided. It is broad and unfocused and because of that it is also fiscally unsustainable and I will give examples of all of this. Firstly let us imagine the deployment of this bill with free doctors visits and three free health checks. What is a doctor’s visit? Well you know that is kind of a hard problem. In fact academics and others have pondered over that for many years. What is a doctor’s visit? Is a blood pressure check a doctor’s visit? Is a repeat prescription a doctor’s visit? When does a doctor’s visit start? Is it when you enter the building? Is it when you check in with reception? Is it when clinical notes are first entered in the computer? You see all this matters because as we know through years of medical audit we need to be able to reliably map service to funding—the details matter.But here in four pages despite others spending many years trying to figure it out it seems like we have an answer. The answer is in the interpretation clause clause 4: a doctor’s visit means to a doctor who is a general practitioner. What a disservice to the largest medical workforce in New Zealand our nursing workforce. Under this bill this lazy definition nurses are incapable of undertaking a health check and I would hotly contest that—lazy drafting. And what of nurse practitioners who run clinics in remote regions—Te Hāpua or Te Kao? Amongst some of the high-risk populations that this bill seeks to reach they would miss out under this bill’s poorly drafted words. A health check—what is that exactly? Is a phone call a health check? Is a blood test a health check? You know it would have been so easy to add a bit more detail and carry the intent of the bill by adding one word: preventive. OK—got it. There are a whole lot of descriptions around what preventive health checks are but no no. It is lazy drafting and it just adds further confusion to an increasingly confused bill.It gets even worse. The bill espouses the aim of “ignoring a minor ailment that could [get worse]”. What is a minor ailment? Because you know the doctor’s code in what is called recoding and systematized nomenclature of medicine—there is no code for minor ailments. It just does not exist. It is a lazy interpretation and lazy drafting. Even if we accept this let us look at two scenarios. An older person thinks they have a minor ailment. They visit a GP and in fact nothing is wrong. Do they then have to pay? Conceivably this could increase the costs to older people. Let us take the other extreme. What about the person who has a major illness who visits under this scheme? Will they be excluded because they do not have a minor ailment? It is poor drafting lazy drafting and exactly the people whom we want to target are not targeted. Therein lies the confusion.If we start at the front of the bill the confusion actually starts in the general policy statement where it reads: “[The bill will have] far-reaching benefits in terms of social emotional physical and psychological wellbeing”. Does the member not think that older Māori might be a target population; if so why does this part of the bill completely miss out one of the fundamentals of Māori health which is spiritual well-being? It is completely eliminated in this description—not interested. Under the most common framework for Māori health te whare tapa whā spiritual health is one of the sides. It is lazy drafting. It misses the target and that is important to this bill—targeting; exactly that. This is a major problem. There is no targeting. Everyone gets three visits despite the fact that 90 percent of New Zealanders report they are in good very good or excellent health and for those over 75 80 percent report good very good or excellent health. There are other targeted tools—very low-cost access high-user health cards prescription subsidy cards.We know the sector would struggle with this bill. As my colleague Barbara Kuriger said the New Zealand Medical Association chair Dr Mark Peterson said that the policy is unnecessary. It is short on detail short on facts and unsustainable. It is short on everything. It is more of a haiku than a bill. It is just short and I cannot commend it at all. Thank you.