Editorial: The puzzle of how to spend health funds

Opinion

Number puzzles exercise an endless fascination. Our readers and millions around the world pore over Sudoku. Mathematicians spend happy careers playing with the Riemann hypothesis and the Kepler Theorem.

So Health Minister Annette King should be grateful she has the opportunity to devote hours to juggling figures in the health spending budgets. Instead, she sounded distinctly tetchy this week after the National Health Committee report on funding issues raised by new health technology.

Finite health dollars had to be spent as effectively as possible and not be based on "someone's pet projects and certainly not on guesswork, presumption or the political flavour of the moment", said Ms King in remarks that could have fallen from the mouth of any health minister for the past 50 years.

The problem is that health spending is less like Sudoku and more like the serpent Orobouros, endlessly circling and coming back to the same place.

There are still some members of the public who believe that if only tax money was spent properly it could meet all our health needs, but everyone else has long faced the fact that spending on demand for health services could suck up our entire GDP and still leave a black hole.

But everyone is, in one way or another, wedded to a pet project. Somebody, somewhere has to say yes or no. And the conundrum remains in finding that someone whose decisions are, as Ms King said, based on the best evidence available.

"Give it to the medical people, they know best" is a popular suggestion. Most doctors are keenly aware of the need to get a bang for the buck, and we can make the generous assumption they do not favour their own specialties for career reasons.

Nevertheless, when it's a contest between dollars and the individual patient's health professionals are bound to come down on the patient's side.

So let's move the decision-making to disinterested officials rather than practitioners. "Oh no," comes the cry. "We can't have faceless types in Wellington making the spending calls. How do they know what Northland needs?"

Right. So let's put the number game to health boards. They have local knowledge and some semblance of democracy, however notional. But then some hospitals manoeuvre a way to fund, say, coated stents in heart artery treatment and other areas will whinge that they have to be content with plain ones. No, that won't do.

So perhaps national politicians do have to make the choices. But nobody trusts them.

Could the answer be to find a few people capable of wearing several hats at once? There is a condition called dissociative identity disorder which used to be popularly known as split personality. But that solution might be self-defeatingly expensive.

Treating just one extreme case of this disorder in Britain is costing some $1.28 million a year, which perhaps neatly sums up the health spending dilemma, a serious issue but one which comes in and out of as many doors as a French farce.

The hard truth is that unless we can persuade the mathematicians having a giggle with the Poincare conjecture to divert their attention, we are likely to continue to suffer messy contradictions and to hearthe sad laments of further generations of health ministers.