by Russel Norman
First it was selling off public assets and now it’s removing the pseudo-cap on the cost of GP visits. National is proposing some very stupid things.
Making primary healthcare more accessible to everyone by reducing fees improves people’s health. It’s a genuinely good thing.
My GP now charges $29 per visit, whereas previously it had been $60. It’s true that Labour’s cap is not absolute but clearly it is having some effect, and if the Nats remove it and fees go up then that is just war on the poor. I would like to see fees drop even further and I wish Labour would move to lower them even more. I grew up in Australia when a visit to the GP was free and the sky didn’t fall in.
I have just come back from the press gallery where Tony Ryall and Jonathan Coleman are busily doing the rounds trying to do damage control with a new press release. Meanwhile David Farrar is spinning over at KiwiBlog to help his team.
The real danger is that National will take off the cap on fees, while keeping the subsidy at the same level. So inflation will erode the value of the subsidy over time and GPs will have to increase fees to compensate. This is how Howard destroyed it in Australia.
National’s arguments in defence of their policy are ridiculous and show a distinct lack of knowledge about how markets work in the real world.
National says if your GP increases their fees, you’ll just go to another – it’s a market. Well it’s not that simple. The GP ‘market’ is sticky – I don’t want to move all my medical records around between GPs chasing the cheapest. And the GP ‘market’ isn’t full of a great many independent providers - many people don’t have the option of going to another GP because there isn’t one nearby. John Key says we can rely on the charity of the rural doctor, but I don’t want to have to beg for medical services if I was unable to pay. Medical care should be a right not a privilege dependent on whether your GP is willing to give charity to you.
Published in Health & Wellbeing by Russel Norman on Thu, September 27th, 2007
Tags: environment
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on the trolls and those who are unable to keep on topic
Greens, not you guys too! As someone on kiwiblog said, a lot of this prejudice against GPs arises because of the 20 year wage control campaign that certain political factions have waged. How many other workers in the country would put up with this?
Unfortunately most statements on this issue are based on unfounded emotive prejudice demonstrating the politics of envy and tall poppy syndrome that we must overcome once and for all in this country, if we are to progress.
If any GPs or other health workers do become rich it certainly isn’t because of their income or working conditions in the health sector, but because they are intelligent hard working people who invest the small amount (comparatively) they do earn wisely.
We are facing incredible problems in this country in sustaining our health service at first world levels because of the global market for well qualified health professionals. It is no use hiding our heads in the sand and pretending the problem doesn’t exist. We do not create the rules, we have to work within them or bend them a bit to suit us if we can.
Recruitment and retention of our valued health workers (doctors, nurses and allied health professionals) is not just about wages and workplace conditions. It is about creating an environment that makes them feel they are part of a team and are providing a valuable service to a public that values their input. Nothing will put these dedicated professionals off faster than an adversarial and prejudiced system that is always seeking to take them down a peg just because certain politically motivated individual have managed to convince the public that they are non-caring fat cats.
The sustainability of our health system is not helped also by the fact that we have had 15 or so years of good economic conditions but the money flowing into the country has been wasted when it could have been used for developing clean lean green industries so we could have afforded cutting edge health provision.
In addition the health system is anything but free – we all pay for it – the taxpayer. Using the words “free health system” is just political deception. And remember these well paid doctors and other health professionals pay an awful lot of tax!
The simple message is that if we want a first class health system we all have to be prepared to pay for it – we all have to work hard and do our bit – it is all our responsibility, not the responsibility of some mythical bunch of health workers willing to endure any sort of wages and conditions and not the responsibility of any one government at the time who have proved themselves incapable of running a sustainable health system that is not incessantly on the verge of bankruptcy.
Let me repeat it – if we want the expertise in this country we have to be prepared to work hard and pay for it. So I ask everyone to stop donging on doctors and nurses and creating an adversarial environment and actually start cherishing their contribution to our health and our economy.
Kevin Hicks, Auckland district Health Board Candidate.
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Russ
You are sure quick to post anything that is anti National, when will we see you publicly state that you would never consider a coalition agreement with them?.
Given that you seem to think that keeping doctors in NZ is a bad thing can you tell me why you have never posted anything here that attacks this govt’s appalling performance in the health sector?
When will we see you post something that asks the following questions
1. How can you inject an extra 2 Billion dollars into the system yet end up with less operations?
2 When will Labour (and its apologists the Greens) apologize to the people of NZ for the shameful way that have treated those on the waiting lists.
Russ it would seem to me Russ that you are more interested in political ideals than you are about health so please don’t pretend that you actually care, if you did you would be hammering the Labour party as well.
P.S …I will donate $20 to the the local branch of the SPCA in the name of the Green party if this post is published unmolested and immediately (the time is 6.31pm)
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Well well….Consider the donation made, who is the Green party candidate for the Piako electorate?
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Unfortunately, for many reasons including a good few mentioned in the post above, there isn’t market liquidity in GPs, there is actually less GP capability than is required. Thus what should happen (classic economics) as demand is greater than supply the price of the commodity should rise to reduce the demand.
So, nothing wong behind the theory. The question is, for the population of New Zealanders, is an increase in the price of GP visits a good thing?
If this were a situation where market rules applied directly, then what should happen is that more suppliers should enter the marketplace, causing price to drop due to increased competition and liquidity. Unfortunately, there is a large barrier to entry to the setting up of a GP practice. It takes years to makea good GP.
The other side of the same coin is recognising the value of GPs. It is unfortunate that those that may be in the greatest need of GP services are least able to pay. Even so, I’m on rather better than an average salary, yet $65 for 15 minutes of a GP on saturday morning still came as something of a shock.
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The main reason more suppliers wont enter the GP market is because the government allows the Medical Association to ration medical training to ensure that demand will always exceed supply. With entirely predictable consequences for patients and taxpayers.
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Medical training is not rationed to keep some mythical priveledged group in the style to which they have become accustomed. It is rationed to make sure there are enough resources put in to produce quality graduates.
In fact we produce more doctors and nurses than we need. The problem is in the globalised market place they can find better jobs overseas or in quango or government bureaucracies like the MOH. You have to deal with that. We could produce five times as many quality graduates but we would just be training them for overseas countries.
The solution is if you want the expertise in a globalised market you have to be prepared to work hard as a nation to pay for it.
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Kevin, nowhere did I attack health workers – many of my best friends etc etc. GPs need to be able to make a decent living and the public need to have affordable GPs. I support a system of subsidies and caps to enable that to happen. And it won’t drive GPs away if they have a decent income and a good health system around them. Many GPs like PHOs because they create a team focussed on primary helath care – but not all GPs like it I grant you that.
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Russel
All well and good but once again you do not have a lash at this Govt, your bias is obvious.
I can just image what you would be saying if the Nat’s wasted 2 billion in the health sector.
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> “many people don’t have the option of going to another GP because there isn’t one nearby”
And why is that?
How come I can shop for the cheapest expertise im virtually every field except, suprise suprise, the one where the state intervenes and actively supports a monopoly; namely the medical profession.
You and your fellow authoritarians are the problem here.
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kevin, You have inadvertantly identified the key problem. Every developed nation has a medical association rationing training. To meet the needs of their ageing and increasingly affluent populations the wealthier nations are left with no option than to poach from less wealthy nations. That means we have to pay more than we can afford for specialists. That means we need to cut costs in the less specialised areas or reduce the need for spedialists.
There are a number of ways that this can be done. Many developing nations have pioneered innovative community health delivery systems. Many of these systems resemble the system of district nurses this country had in the early twentieth century. To reduce carbon emmissions and prepare for the looming peak oil crises we should be looking at these types of decentralised health delivery systems anyway.
The need for specialists and the use of their time can be reduced by using computer based specialist systems to improved diagnostics at the GP level. Unfortunately the medical professions are unhealthily wedded to traditional delivery systems. Look at how long it took for the trauma management systems developed during the Korean war to be adopted outside of the military. Paramedics, rescue helicopters, trauma teams. We could have had them in the 1950s but we didn’t get them till the 1990s. It only took 25 years to get from Spitfires to Concord and the 747 and from the V2 to men on the moon and Telstar in orbit. There are good reasons why medicines and surgical advances need time to be proven but the systems have already been proved in a multitude of industries. Frankly I would trust a health system run by Toyota infinitely more than the one run by doctors, and quite a bit more than one run by nurses. The continuous improvement mentality demands that elites get down off their high horses and listen to those who are in the best position to see how their bit of the process can be done better.
To be completely blunt, the medical “establishment” make the American car industry look innovative and efficient.
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