Comment: While it’s encouraging to see health supported so well in Budget 2026, the devil is in the detail.
More money for frontline services, mainly in the hospital sector, is great. However, it’s a naive and short-sighted approach not to invest more in primary healthcare as well.
We have known for many decades that primary healthcare is the cornerstone of preventative and equitable care. There is evidence from across the world that strong primary healthcare systems can benefit health and decrease health inequities.
We also know from New Zealand evidence that barriers to primary healthcare result in emergency department and hospitalisation usage.
Moreover, many hospitalisations—both in children and adults—that fall into the category of ambulatory sensitive hospitalisations (ASH) are avoidable. These are conditions that are understood to be preventable if primary healthcare is available and accessible.
Healthcare provided in hospitals is significantly more expensive than that provided in the community. Unfortunately, Budgets are driven by short political cycles and short-term gains. If political cycles were put aside, and a longer-term view was used, every health and economic argument would favour significant investment in primary healthcare.
What about the other funding announcements in this year’s Budget?
The funding contribution to ambulance services, which was announced earlier in the week, is very welcome. But a braver choice would be to move the ambulance service away from being charity funded, to a recognised and fully-funded player in the primary healthcare sector of which it is a key part.
The previously announced investment in paediatric palliative care is also welcome. This is an area that has been neglected in Aotearoa New Zealand. However, as with the ambulance service, to see hospices funded to a significant degree through charitable donations is not a sustainable model of healthcare delivery.
The extension of eligibility for bowel cancer screening to those aged 56 (down from age 58) is encouraging. However, as was identified when differential access to bowel screening was removed for Māori and Pacific people, having a one-size-fits-all approach does not address inequities in bowel cancer outcomes.
We know Māori are more likely to get bowel cancer before the age of 50 and therefore do not benefit from the screening programme as it is currently delivered. On a total population level, reducing the age of screening to 56 years benefits many people, but this approach will continue to fail to address the inequities in bowel cancer outcomes for Māori.
The Budget also included capital expenditure on health infrastructure, which is welcome but unlikely to be sufficient. And the announced investment in technology comes on the heels of a significant reduction in the data and digital teams within the public sector, meaning that a reasonably small level of investment is unlikely to be sufficient to make sure the healthcare delivered is benefiting from available systems.
The extra money for Pharmac? Again, the funding is welcome but unlikely to be anywhere near sufficient. Not only does this investment need to cover increases in the price of drugs, but it is also meant to fill the shortfall caused by decades of underinvestment.
There are many drugs that Pharmac has clinically approved in principle but cannot currently afford to fund. These are on the “options for investment” list and cover many cancer drugs, as well as drugs for conditions affecting the gastro-intestinal and nervous systems, among others.
Better funding of drugs is likely to save some health system costs so, as with primary healthcare, it can be seen as an investment while benefiting a wider group of people. It will also address inequities, since people with funds to pay for drugs privately can currently access better healthcare than those relying on the public health system.
In summary, although none of the items in the Budget can be argued with, the omissions—and levels of funding—are likely to mean the health system will continue to struggle over the coming months and years.
This article was originally published on Newsroom.
Mona Jeffreys is an associate professor in the School of Health at Te Herenga Waka—Victoria University of Wellington.