In Rotorua, my dentist has left for Queensland. Two days a week, the clinic flies in a
dentist from Auckland. It took six weeks to get an appointment. I was advised to see the specialist who installed the crown.
Last week when I attempted to contact the specialist, I was told by that clinic that not only had the specialist left, but the clinic had not had a dentist all year.
The coalition Government did not create the health crisis. It will not be solved this term. Sir John Key is right that only fixing the economy can halt the brain drain.
These are not excuses to make the health crisis worse.
The Health NZ board the Government fired was more competent than most of Labour’s appointees. The board had an impossible task to efficiently manage a centralised administration. Health is too big and complex to be run from Wellington.
Four regional organisations will be too large for effective management.
The problem with the district health boards was they were too big.
Rather than top-down management, devolving decision-making to those who are making patient health choices would be the best management.
Dr Shane Reti, the Minister of Health, may be right that the health system is suffering from reorganisational fatigue, but he is making National’s classic mistake. Criticising Labour’s reforms in Opposition and then believing that by better management, National can make Labour’s policies work.
The coalition has wasted a year. It was always obvious Labour’s health structure was unworkable. Setting up a regional structure will waste the term.
I suspect the Gibbs report finding that the most inefficient private hospital was more efficient than the most efficient public hospital is true today as it was 40 years ago. Private hospitals mostly manage themselves.
The coalition drug-buying decisions raise more questions.
National’s election promise was to fund 13 named cancer drugs. The coalition has announced that 54 more treatments will be funded. “Pharmac estimates around 175,000 people will benefit from the additional medicines in the first 12 months,” said Reti.
That is the population of Hamilton.
Do these new drugs mean fewer hospital stays? Why were these drugs not funded by Labour? Is it the best cost-benefit use of the health vote? I suspect no one knows the answers to these questions.
There are miracle cancer drugs. Two of my relatives’ lives were extended for years. One was told she would not see Christmas when she received a letter from Pharmac saying she had been randomly selected for a cancer drug trial.
Will all the drugs be beneficial? Forty years ago, my daughter, who is a cancer nurse, told me that Auckland Hospital was spending a quarter of a million dollars per leukaemia patient for a drug she had never seen cure a patient.
Why these drugs? I have seen the rushes for a documentary series, Lose weight or die, about Maori flying to India for gastric surgery. Despite being grossly overweight and it endangering their lives, they could not get the operation in a public hospital.
In Australia, the diabetes drug Ozempic is being prescribed by doctors for weight loss. It is virtually impossible to get the drug in New Zealand. I know people who fly to Australia to get Ozempic.
If obesity were a big killer of Pākehā, would Ozempic be funded?
Health will always be an issue because the demand for a free service is infinite. There is no one right answer to these questions. We all make different choices.
But there are wrong answers: making drug-buying decisions by election promises; claiming, as I heard Chris Hipkins say, that the Government can solve the health crisis by spending more money.
Perhaps the best health system is Singapore’s, where there is universal health insurance. Health issues are decided by the state and the individual taking responsibility. I doubt a system where we take more responsibility for our health is politically feasible.
Economics professor Robert MacCulloch’s blog Down to Earth Kiwi has made a practical suggestion on how to improve our “free” health system. Rather than the Government micro-managing health, “run healthcare along similar lines to how our general practitioners, medical laboratory testing and Pharmac are already working. That is, the Government would not only negotiate prices for GP services, lab tests and drugs, but hospital medical procedures as well. Private and public hospitals then compete on quality to provide services at those agreed prices.”
He writes, “If you think private health suppliers can’t be trusted, think again. Kiwi GPs already run their own private business; each drug you use, bought by Pharmac, is already privately produced. Medical tests in NZ are already done by private suppliers”.
Reti should appoint the professor as his adviser.
