The day before Budget

'Twas the day after Budget, and all through the town

The surgeons were reeling the GPs were down.

The hospitals all murmured how can we care

For even more patients when our coffers are bare.

That was me, writing back in 2001, I suspect at my wits’ end after another day of rifling through printed and bound Budget books, picked up under embargo from the central Post Office as they would have been back then, in search of some good news for primary care.

Today, in 2024, I am writing the day before Budget, at a loss as to where to start – given the predictions are rather glum for a large injection of cash for primary care. So, I headed into our online archives, which start in 1996 when Vote Health was $5.495 billion; that’s compared to last year’s $26.51 billion.

The numerical value of the Vote has changed mightily. But the headline has a familiar ring, “GPs are yet again Budget casualties” and, likewise, the first sentence of our Budget wrap-up story in 1996: “The ‘96 Budget announced by finance minister Bill Birch contains little support for primary healthcare – even though it is the one arm of healthcare affecting most New Zealanders.”

The following year saw the introduction of an initiative specifically targeting primary health – free doctors’ visits and prescriptions for under-6s ($61.4 million per year).

But by 1998, under the headline “Health money peters out” we were reporting: “Treasurer Winston Peters’ 1998 Budget rehashes old news and confirms money previously announced. There are no new or specific initiatives for primary care.”

It feels like a pit stop in the political year, with potential to refuel the Government’s popularity tank, but equally as likely to drain the brake fluid

And so, it waxes and wanes over the years, irrespective of political colours:

2001: “Maternity rates a mention in this year’s Budget but primary care spending represents only around 10 per cent of the new money in Vote Health.”

2003: “The only new money announced for primary care, pre-Budget, is $8 million – the first regular funding adjustment for PHOs.”

2007: “It’s not a big Budget for the health sector but more money for elective surgery and a boost for aged care is on the books.”

2009: This was an auspicious year, with National health minister Tony Ryall capturing over 40 per cent of all new government funding for health. Money pledged by the former Labour Government for Primary Health Care Strategy continued to roll out.

2011: “The health sector is being squeezed by about $165 million this year as the Government digs into existing spending to find $585 million for new health initiatives in Budget.”

2014: It was the year the Budget introduced free care for under-13s, that was a surprise for general practice – no one had worked out what level of subsidy general practice would get in return for free care for this age group.

2016: “Today’s Budget gives a nod to primary care in the half a billion dollars of extra health funding it contains for the year ahead.”

2017: “The Budget released by finance minister Steven Joyce today contains a relatively small increase for the primary care subsidy programmes the sector has been desperate to see reformed.”

2018: “The Government has made significant moves in today’s Budget to increase access to primary care – extending free GP visits and prescriptions to under-14-year-olds, and greatly increasing the use of the Community Services Card to access VLCA services.”

2019: “The funding will maintain the value of funding paid to primary care services in response to demographic, demand changes and price pressures.”

Then along came COVID-19, with no precedent set for spending. And now, four years later, austerity rules. Overall, looking back at Budgets past, there’s a general trend of dollops of money for primary care every few years, but mostly tied to new initiatives so therefore not addressing the wider issue of sustainable funding. You only get more money if you do more stuff. The Government looks good but primary care just boxes on.

The Budget is an odd beast. As a child, I remember the adults filling the petrol tanks and stocking up on cigarettes ahead of Budget changes. As an adult, it feels like a pit stop in the political year, with potential to refuel the Government’s popularity tank, but equally as likely to drain the brake fluid, causing trouble ahead.

Either way, it helps give us the measure of our political leaders – made all the more difficult this year by the three-way coalition. It will be interesting to see who rules the coffers.