As we are all patients at some point in our lives, the ongoing health system crisis is all of our concerns. This piece describes our crisis wonderfully:
What can we do?
I would hope that proper investment in digital health/informatics could improve efficiencies and waste if prioritised and implemented sensibly. I wonder how much funding is wasted in healthcare due to inefficient and ineffective services that are not monitored properly that could be better spent on preventative programmes. Muir Gray has a thought-provoking letter in the BMJ on this:
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Agreed . . this still requires upfront investment! It seems Hira has disappeared?!?
Like our physical infrastructure that has been woefully under-invested in, it is clear it costs more in the long-run to clean up natural disaster destruction and the consequences of an inefficient health system . . .
The fact that politicians get to determine how much is spent to maintain our well-being seems a breach of our rights. How could we demand that our GDP spend on health ‘must’ be en par with our OECD equivalents?!?! (>10% of budget)?
It just is so frustrating that the current narrative is an ‘over-spend’ . . who determined the budget, and on what grounds?? This article clearly articulates this ‘budget’ restriction kōrero is utter rubbish.
Is the following excerpt from the article controversial? If not, what about addressing and advocating for legislative changes to the 1938 Social Security Act and replace this with mandatory proportional GDP spend equivalent to equivalent countries AND related to equity?
Also important is the two-tiered nature of the New Zealand health system. The 1938 Social Security Act, which created the publicly-funded system, aimed to ensure health services would be free and accessible to all citizens. Now, however, primary health care is not affordable for around one in eight New Zealanders.
The problem goes back to the original compromise between the government and the medical profession. GPs retained the right to operate as private businesses, receiving government subsidies while also charging patients consultation fees. Doctors in public hospitals became salaried, but were allowed to operate a parallel private practice.
Consequently, better-off people could access health services more quickly in the private sector. No government since has been able to shift these arrangements, despite the considerable inequities of access they entail.
Would other funding models work?
For more than 80 years, the basic design of the publicly-funded health system has served us well, even with the two-tiered design flaws. Around 80% of the health system is funded publicly through taxation, a model we share with the UK, Spain and Scandinavian countries.
Given 37% of New Zealanders currently have private insurance, would a greater role for private funding reduce pressure on public funding? International experience tells us no.
The private insurance-based US health system is by far the most expensive in the world, soaking up nearly 18% of GDP. The prices paid by private insurers for health services have increased significantly faster than public parts of the US system.
[. . . .]
In tax-based systems, rationing due to funding shortfalls is more visible in the form of waiting times and waiting lists. In private insurance-based systems, rationing is based on affordability and is far less visible.
Wondering where HIRA went? To Payroll…
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Oh my . . . . what can we do? Why are we spending so little on healthcare ?? The deficit-framing about it’s the healthcare system’s ‘fault’ for ‘overspending’ is driving me nuts . . . what about the fact that we are contending with decades of UNDER funding, and this is making it worse?!?!
Interesting read. Looking at the updated data re spending from OECD dataset, it was estimated NZ spent a higher percentage of GDP on health than Australia and Canada (and most comparable countries) in 2022. Suggests historic relative underspend here, with a recent sharp increase in spending through 21, 22. I will be interested to see the 2023 data when updated.
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