Editorial highlights same old story: hospitals first, communities last

Primary and Community Health Aotearoa (PCHA) has reviewed Dr Lester Levy’s recent editorial in the New Zealand Medical Journal and is deeply concerned that once again, primary and community health is reduced to an afterthought in the national reform narrative.

The editorial lauds financial recovery and hospital performance improvements but fails to meaningfully address the real frontline of health — the GP clinics, hauora providers, community nurses, allied health professionals, and aged care workers who deliver 90% of New Zealanders’ care.

“Hospitals are critical but focusing on deficits and waiting lists while recouping hundreds of millions from already stretched community services is not reform — it is recycling an old, broken model,” said PCHA Chair, Teresa Wall.

In July, PCHA criticised Health New Zealand’s move to claw back $270 million in so-called ‘savings’ from primary and community health, a sector that has been chronically underfunded for decades. That $270m is not a saving; it is a cost shift that will resurface in emergency departments, specialist services, and hospital wards.

The Government has recently announced a suite of primary health funding initiatives — including capitation uplifts, urgent care expansion, digital access tools, and rural support. PCHA acknowledges these as positive and necessary steps. However, these initiatives are incremental and fragile gains, and they are being delivered in the same breath as the $270m clawback, which wipes out the benefit many times over.

“It is like giving with one hand and taking away with the other,” said Teresa. “The new funding is welcome, but it does not undo the chronic underfunding of community care, and it is completely undermined when the system simultaneously strips hundreds of millions from the same sector.”

The irony of this approach is stark: the stated goal of the health reforms is to keep people well and out of hospital yet cutting investment in the very services that prevent ill-health and manage conditions early will do the opposite — it will drive more people into hospitals, at greater cost to taxpayers and with worse outcomes for whānau.

New Zealand data illustrates this clearly: an emergency department visit costs around NZ$650, while a GP consultation costs about NZ$50. Starving primary care of resources only ensures more New Zealanders will end up in the most expensive part of the system.

Focusing only on hospital costs is like mopping the floor while ignoring the leak in the roof, it treats the symptom but not the cause.  Real reform requires looking at the health system in its totality: fixing the leak upstream in primary and community care so that hospitals are not flooded downstream.

PCHA believes this approach risks repeating the mistakes of the first phase of the reforms:

·     Communities are sidelined while financial levers dominate decision-making.

·     Equity gaps are ignored, particularly for Māori, Pacific, rural, and low-income whānau.

·     Workforce strain intensified, with general practice and hauora services expected to do more with less.

·     Prevention was de-prioritised, leaving hospitals to pick up the consequences of unmet community needs.

“It is misleading to call this recovery. Balancing books in hospitals while stripping capacity from primary and community care is a false economy; it simply pushes costs downstream,” said Teresa.  “Without genuine investment in community-based care and system-wide innovation, we will never break the cycle of hospital overload.”

PCHA calls for a fundamental re-balancing of investment and system design, with primary and community health at the centre of reform. Hospitals will always matter — but without a strong, well-resourced community foundation and a system that values prevention, equity, and innovation, the health sector will remain in crisis, inequities will worsen, and long-term costs will escalate.