Tim Parke compares the pros and cons of New Zealand and American healthcare
The likely new Speaker of the US House of Representatives, John Boehner, is very clear that the US has the "best healthcare system in the world". And that it should not be changed by President Obama, or anyone else for that matter.
Universal public health care, such as in New Zealand on the other hand, is widely portrayed by the American Republican Party as a dangerous, ineffective, bloated socialist idea that produces mediocre results. And that it regularly kills patients through error and neglect and risks bankrupting the country through taxation.
This view now appears to be finding some traction with certain business leaders, politicians and economists in New Zealand. They argue the recession means we must downsize universal healthcare, especially in public hospitals, to spend less tax revenue on health.
The private health sector will pick up the additional work and financial incentives such as tax breaks should be given to those who choose to pay directly for their healthcare.
So would being more American, more commercial, about the whole business of looking after the sick and injured work better for NZ in terms of outcomes, safety and economics?
How does the New Zealand system of large public hospitals, subsidised GP networks, ACC insurance and small private hospital contribution perform relative to highly privatised US healthcare?
The information to answer this is freely available from the independent OECD data published last year.
Life expectancy is higher in New Zealand (and all other countries with integrated public systems) than in the US, despite their spending more than double the GDP percentage of any other country on health.
Outcomes in this country from heart attack, stroke, cancer and trauma are similar to or marginally better than the US (with a couple of exceptions such as breast cancer).
Infant mortality and premature death are very much higher in the US. Using WHO data, Newsweek magazine recently placed New Zealand equal 4th in the world for health (the US is 26th).
Mercers also named Auckland and Wellington in the top 15 cities in the world to live in, with availability of accessible affordable health care being a major determinant of the score. No US city made the top 30.
Are public hospitals inherently unsafe compared with private facilities?
Faith in public hospitals has been undermined undoubtedly by multiple press anecdotes of adverse outcomes, which appear less regularly from the private sector. This fuels the notion that the public system is in crisis.
However, there are very much lower volumes, less reporting transparency and less complex and risky procedures being undertaken in private facilities.
In fact, when adverse events occur in the private sector the patient is usually immediately transferred to the public hospital so they can receive a higher level of care and expertise.
Avoidable error certainly does occur in public hospitals but there is no inherent complacency. Critical incidents are openly reported by DHBs annually, and overall, the public hospital error rate here is similar to that of other mixed healthcare systems, such as in Australia.
Why should taxpayers be forced to cover people who don't make health provision for themselves and their families?
The US experience would suggest that absence of universal health care does not act as an incentive for citizens to work hard and make provision for themselves.
Instead, market forces push the cost of healthcare up to the point of maximum profitability for the organisations and healthcare professionals.
At this point many people can no longer afford it, so they rely on the state safety net. However, those paying directly for their healthcare become disinclined to pay tax to support the public system, allowing it to become progressively underfunded.
Such resulting inequality and social division have been convincingly linked to a range of poor health outcomes and quality of life standards.
The corollary is also true in that too much care may occur in the private system for the well-off, where doctors get paid to operate and are sued if they miss anything. This subjects many patients to unfounded anxiety, unnecessary radiation from scans and unwarranted surgical procedures.
One study estimates an additional 1200 cancers per year in the US will occur due to the widespread practice of "pan-scanning" - taking patients through a CT scanner from head to foot after a motor accident to avoid missing an injury.
There are estimated to be 12,000 deaths a year from unnecessary surgery in the US. Thus with under-provision at the bottom and overprovision at the top, everyone is worse off, and the lowly position of the US in the health tables makes sense.
The New Zealand system of universal public healthcare provides better care and is inherently more efficient. Money is not spent on billing (estimated at 10 per cent of US healthcare budget).
Bulk drug purchasing, and nationally negotiated terms and conditions for a highly trained workforce tend to further contain costs. Furthermore, the highly paid specialists working in the public system often work beyond contracted time to satisfy their professional pride in their work and provide a decent public service that they and the community are proud of.
During this recession, investment of tax revenue in expanding equitable public healthcare (as with education and public transport) is more likely to move a society forward and provide economic spin-offs in terms of employment and social mobility.
Is this not a better investment than bailing out private finance companies or the movie industry where the returns may be less widespread?
* Dr Tim Parke is clinical director of the adult emergency department, Auckland City Hospital.
