The patients' complaints system in New Zealand

Since 1996 New Zealand has had a Code of Patients' Rights enforceable by complaints to an independent ombudsman. Patients are entitled to receive health care of an appropriate standard, to give informed consent, and to complain to a health commissioner about perceived malpractice. The commissioner investigates and reports on complaints, recommends practice changes by providers, is a gatekeeper to discipline by professional boards, and acts as a public advocate for patient safety. In this paper the current commissioner describes New Zealand's experience with the patients' complaints system and discusses the implications for the quality of health care.     

Homicide in New Zealand: an increasing public health problem

Abstract: Injury purposely inflicted by other persons is a significant public health problem as well as a criminal problem. It accounts for approximately 3 per cent of all deaths from injury in New Zealand. National injury mortality data for the period 1978 to 1987, supplemented by reference to files of the Coroner's Court and the High Court, were used to identify the characteristics of victims of homicide, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The mortality rate from homicide for the 10-year period was 1.6 per 100 000 persons per year. A significant increase in the rate of homicide was identified. The rates for males were higher (2.0) than those for females (1.2), with those 20 to 24 years of age most at risk. Maori had higher rates than non-Maori. Homicides were most frequently committed with cutting and piercing instruments, and most commonly occurred in private homes. Homicides were most likely to occur on Fridays or Saturdays, between the hours of 6 p.m. and 6 a.m. In 55 per cent of homicides the victim and assailant were known to one another. Unemployment, membership of ethnic minority groups, availability of weapons, the private nature of interactions in the home, alcohol consumption, and stress in personal relationships were all identified as factors associated with homicide in the decade under study. The implications of these findings for the prevention of injury from assault are discussed.     

试论卫生监督投诉举报的调查处理

对卫生监督投诉举报现状进行了分析 ,结果提示整体上数量逐年上升 ,投诉举报方式以来电形式为主 ,其次为来人来访和来信书面等形式 ;投诉举报内容以食品卫生最多 ,其次分别为医疗机构管理和其他公共卫生的内容 ;投诉举报动机多种多样。卫生监督投诉举报具有调查的即时性、行为的复杂性和查处的艺术性等特性 ,应遵循受理登记、调查取证和处理等程序进行查处 ,并提出了调查处理的要求。     

Injury from assault in New Zealand: an increasing public health problem

Abstract: Injury purposely inflicted by other persons is a significant public health problem accounting for approximately 4 per cent of all injury hospitalisations in New Zealand. National injury morbidity data for the years 1979–1988 were examined. These data were used to identify the characteristics of victims of assault who were hospitalised, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The incidence of hospitalisations in 1988 was 73.7 per 100 000 persons per year. A significant increase in the rate of hospitalisations over the decade 1979–1988 was identified. The rates for males were higher than those for females, with males 20–24 years of age most at risk. Maori had higher rates than non-Maori. Fights or brawls were the leading cause of hospitalisation. The most common place of occurrence was private homes, followed by streets and highways, and licensed premises. The findings with regard to age, sex, employment status and use of weapons were consistent with earlier studies. A higher proportion of incidents occurring in the home was attributed to differences in selection of cases between studies. An indication of underreporting by women was attributed to concealment of intentionality, possible owing to fear of reprisal. Standard hospital reporting procedures were proposed as a means of improving identification.     

The first sunrise: an experience of cultural immersion and community health needs assessment by undergraduate medical students in New Zealand

CONTEXT: Cultural factors in health and illness, and an awareness of community health needs analysis, are important issues for medical education. Both have received relatively little recognition in the medical education literature. This paper describes the development of an educational attachment to remote predominantly Maori rural communities in New Zealand. The twin purposes of the programme were to encourage students to adopt broad public health approaches in assessing the health needs of defined communities, and to increase their awareness of the importance of cultural issues. METHODS: During a one week attachment, 51 students from the Wellington School of Medicine were hosted in six small communities in the East Cape region of New Zealand. Students gained an insight into the health needs of the communities and were encouraged to challenge their own attitudes, assumptions and thinking regarding the determinants of health and the importance of cultural factors in health and illness. The programme included both health needs assessment and cultural immersion. Students made visits with primary health care professionals and were also introduced to Maori history and cultural protocol, and participated in diverse activities ranging from the preparation of traditional medicines to performing their own songs in concert. CONCLUSIONS: The students evaluated the course extremely highly. Attachments of this sort provide an opportunity for students to appreciate how cultural values have an impact on health care, and how they also make the teaching and learning of topics such as community health needs analysis an enjoyable and dynamic experience.     

Public health and the reforms: the New Zealand experience

The main aim of a national public health service is to conserve and improve the population's health. The health service reforms introduced in 1992 proposed the establishment of a Public Health Commission, which was to be responsible for health monitoring, public health policy advice and the purchase of public health services. These reforms, implemented in 1993, while emphasising a purchaser-provider separation also earmarked a budget for public health activities to be administered by the Commission. Such protection of funding is unusual. Public health activities span a wide range of measures to protect and promote health as well as to prevent disease. Many of these measures have been, and will continue to be, carried out at a local level. The results of some of these measures are not usually seen in the short term. Improvement of the population's health also requires proactive measures which are outside the traditional health service. The demonstration of quantifiable benefits to the public's health from such measures may require an even longer term. It is mainly in this area of activity, however, that the achievements of the Commission will be judged. Beginning with a short summary of the history of public health services in New Zealand, this paper looks briefly at the events that led to the establishment of the Public Health Commission, before moving on to describe its achievements to date, the challenges it faces and its impact on public health service provision. Based on such observations and an analysis of the strengths and weaknesses of the Commission, the paper attempts an appraisal of the public health function in the reformed health service, a function that will almost certainly be observed with interest in other countries. Certain ways of improving the public health function are outlined in the conclusions.     

Self-reported sleep complaints are associated with adverse health outcomes: cross-sectional analysis of the 2002/03 New Zealand Health Survey

Objective: The aim was to investigate the prevalence of self-reported sleep complaints in New Zealand adults and determine the independent association of sleep complaints with adverse health outcomes.

Design: We used 2002/03 New Zealand Health Survey data (n?=?12,500 adults, ≥15 years). The prevalence of self-reported sleep complaints was estimated by ethnicity. The relationship between sleep complaints and mental health, physical health and health risk behaviors were investigated using multivariable logistic regression models.

Results: The prevalence of each sleep complaint measure was highest for the indigenous Māori population (23.6% reported ‘any’ sleep complaint; 10.3% reported multiple sleep complaints). Reporting ‘any’ sleep complaint was associated with higher odds of poorer mental health, diagnosed high blood pressure, diagnosed diabetes, diagnosed heart disease, poor/fair self-rated health, obesity, current smoking, and hazardous drinking.

Conclusion: The higher prevalence of sleep complaints among Māori and the consistent association with poor health suggests a potential role for suboptimal sleep in ethnic health inequities.     

Determinants of non-response in an occupational exposure and health survey in New Zealand

Objective: Study the determinants of non‐response and the potential for non‐response bias in a New Zealand survey of occupational exposures and health. Methods: A random sample of 10,000 New Zealanders aged 20–64 years were invited by mail to take part in a telephone survey. Multiple logistic regression was used to study the determinants of non‐response. Whether occupational exposure, lifestyle and health indicators were associated with non‐response was studied by standardising their prevalence towards the demographic distribution of the source population, and comparing early with late responders. Results: The response rate was 37%. Younger age, Māori descent, highest and lowest deprivation groups and being a student, unemployed, or retired were determinants of non‐contact. Refusal was associated with older age and being a housewife. Prevalence of key survey variables were unchanged after standardising to the demographic distribution of the source population. Conclusions: Following up the non‐responders to the mailed invitations with telephone calls more than doubled the response rate and improved the representativeness of the sample. Although the response rate was low, we found no evidence of major non‐response bias. Implications: Judgement regarding the validity of a survey should not be based on its response rate.     

New Zealand health care: a background

New Zealand, its people and health care services are described, followed by a discussion of (i) the role of government and non-government agencies in the funding, provision and purchasing of health care and (ii) persistent problems in the health care system. The authors argue that recent New Zealand health care reforms represent a significant deviation from past policies. However, to have any prospect of being judged as successful, the reforms must address difficulties in the funding, purchasing and provision of health care that are not new but have been features of New Zealand health care over many years.     

Racism and health: the relationship between experience of racial discrimination and health in New Zealand

Accumulating research suggests that racism may be a major determinant of health. Here we report associations between self-reported experience of racial discrimination and health in New Zealand. Data from the 2002/2003 New Zealand Health Survey, a cross-sectional survey involving face-to-face interviews with 12,500 people, were analysed. Five items were included to capture racial discrimination in two dimensions: experience of ethnically motivated attack (physical or verbal), or unfair treatment because of ethnicity (by a health professional, in work or when gaining housing). Ethnicity was classified using self-identification to one of four ethnic groups: Māori, Pacific, Asian and European/Other peoples. Logistic regression, accounting for the survey design, age, sex, ethnicity and deprivation, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Māori reported the highest prevalence of "ever" experiencing any of the forms of racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific peoples (25%). Māori were almost 10 times more likely to experience multiple types of discrimination compared to European/Others (4.5% vs. 0.5%). Reported experience of racial discrimination was associated with each of the measures of health examined. Experience of any one of the five types of discrimination was significantly associated with poor or fair self-rated health; lower physical functioning; lower mental health; smoking; and cardiovascular disease. There was strong evidence of a dose-response relationship between the number of reported types of discrimination and each health measure. These results highlight the need for racism to be considered in efforts to eliminate ethnic inequalities in health.     

Transforming health sectors: new logics of organizing in the New Zealand health system

This paper develops a relational analysis (drawing on the insights of historical institutionalism and economic sociology) of the ongoing process of radical health sector restructuring in New Zealand. The original 'reforms', based on a 'purchaser provider' split, are outlined so as to emphasize their politically consequential ambiguity: was restructuring about revitalizing an essentially public health system or about creating the basis for an eventually private health system with a residual state role? The actual process of restructuring is then traced, emphasizing the responses it has evoked from differently situated actors within the health sector as this is entwined with the political system. The focus is on explaining the largely unintended consequences that have resulted, including the abandonment or significant modification of most of the originally enacted forms of organization together with the emergence of new organizational forms, initiated by providers, and largely unanticipated by the restructurers.