by Kevin Hague
The Health Select Committee today heard evidence from the NZ Surgical Hospitals Association (essentially the private hospitals club). Essentially they were pitching for Government to contract more elective surgery to them and also to encourage more New Zealanders to take out private health insurance, by giving tax breaks for this.
One unexpected feature of their evidence though was to refer to remarks made by John Key at the recent opening of a new private hospital. By their account the PM had said that the biggest financial consequence of our aging population would not be the mushrooming superannuation liability, but rather the mushrooming cost of health care and disability support services.
If he said this he is right, of course. Older people use more (and more expensive) health services. This effect will be compounded by the surging incidence of long term conditions like diabetes, COPD and depression, meaning that we should anticipate the demand for health and disability support services to soar.
What is surprising about Key’s remarks is that his Government has just adopted and applauded a budget that contains a significant increase to Vote Health for the 09/10 year, but that thereafter intends to decrease health spending in the next few years at least. That’s right: burgeoning need but dwindling funding.
Last week the Select Committee’s guest was the Minister of Health, Tony Ryall. I asked him about the Healthy Eating, Healthy Action programme. If we want to do anything about limiting the growth in these long term conditions then we need to take steps that will improve the food that people eat and increase their level of physical activity. I asked about the cuts to the Healthy Eating projects. Initially the Minister said that the programme had been “rebalanced” with some of the HE funding being transferred into the HA. When I pressed him, he conceded that this rebalancing would be taking place with a lower overall level of funding for this area of work.
I then asked him about the National Party’s pre-election pledge to axe funding for Push Play, the flagship for healthy activity promotion in New Zealand, and the already cut Mission On programme. He didn’t know anything about that. What a surprise.
More need. Less investment in programmes to reduce it. Less funding for treatment.
And the extra money for next year’s budget? A substantial proportion is headed for building extra operating theatres for elective surgery, while many of our existing public hospital operating theatres stand empty and the private hospitals told us today that they had the equivalent of more than 50 operating theatres empty and available around the country.
When I asked the Minister if there were any evaluations of the HEHA programmes he was cutting that indicated that they were not effective, he indicated that there were not, but that the decisions instead reflected Government policy.
Could it be that the Government is driven more by short term populism than long-term, evidence-based thinking? More Herceptin anyone?
Published in Environment & Resource Management by Kevin Hague on Wed, June 24th, 2009
Tags: Budget, elective surgery, health, hospital, Kevin Hague, poltics
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on the trolls and those who are unable to keep on topic
“Could it be that the Government is driven more by short term populism than long-term, evidence-based thinking?”
Duh.
How could it be otherwise? When you make anything a government responsibility you are making it a political football to be used for party and career advancement by grubby little MPs whose overriding priority is getting re-elected.
This is one (very powerful) reason why the state should have nothing to do with healthcare provision; it’s simply too important.
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…while many of our existing public hospital operating theatres stand empty…
What do you base that assertion on? It seems like half the reason that thousands of people buy health insurance is that they can’t rely on the public system to operate on them quickly, but you’re saying that is not the case?
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“If we want to do anything about limiting the growth in these long term conditions then we need to take steps that will improve the food that people eat and increase their level of physical activity.”
Or you do things the easy way – you make those people who need hospital care for conditions that they brought upon themselves pay for it. You don’t need government funding to tell you to cut down on the amount of food that you are eating, if you are obese, it should be pretty obvious.
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If there are operating theatres standing empty in public hospitals, it’s not because of a shortage of patients. It’s most likely to be due to a shortage of money to pay surgeons to operate in them (many top public hospital surgeons supplement their income doing routine surgery in private hospitals, because they can’t get a full week’s work in the public system).
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Stephen, I have requested the hard data on theatre utilisation rates and will put this up here when I have it, but it is from personal knowledge as a previous DHB chief executive that I know that many of our public hospital theatres are empty much of the time.
The reasons for this are multiple. For example it is standard practice to retain theatres and theatre teams on standby to deal with acute surgical need, but while it’s waiting to be used for that purpose it can’t be used for elective surgery. Another reason in some places is that we don’t have sufficient staff (not only surgeons but theatre nurses, theatre technicians, anaesthetists, anaesthetist technicians). Sometimes that’s because we don’t train enough. Other times it’s because we train enough only to see them head overseas (in part, usually, to be able to repay student loans faster – what a great policy that is!)
Most importantly, though, it’s a problem of queueing. In general the more queues you have, the longer waiting times become. That is because more demand than supply in any of the queues increases those waiting overall, but more supply than demand doesn’t reduce it. Imagine a bank. Most or all have now shifted to a system of a single queue of customers with each person going to the next available teller. What we do in surgery is the equivalent of each teller having their own queue, with nobody being able to shift queue. Pretty soon in the bank we have some tellers doing nothing while cutomers are waiting longer and longer.
Obviously that’s an oversimplification (a bit) but we have 21 different queues for the same service in most cases for elective surgery. On the West Coast, where I worked previously there were some procedures that people waited ages for because we couldn’t get the specialist staff. But there were also procedures that we were able to carry out with waiting times in days, compared with more than 6 months for the same procedure in Canterbury.
What makes sense here is logistical planning. Let’s have one queue for each procedure in New Zealand, provide procedures locally where possible, but also move both staff and patients around as required to maximise what the system can produce. Faced with the choice of waiting longer or traveling to have an operation the answer from patients is almost always to favour the least waiting time. This also is what will minimise the consequences of illness and disability both to individuals and their families, but also to our economy and to wider society.
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Sorry to dominate but thought I should also respond to Kahikatea’s point. The reason that surgeons work some of their time in private is not usually that there in’t enough work in public, but rather that they get paid much. much more working in private. Of course this sets up a feedback loop: because they spend some of their time working in private, the capcity of the public system is reduced and demand for private surgery increased.
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Kevin Hague Says:
June 25th, 2009 at 10:12 am
> The reason that surgeons work some of their time in private is not usually that there in’t enough work in public, but rather that they get paid much. much more working in private.
I stand corrected. I was basing my statement on one surgeon I know, and I expect you know the motivations and circumstances of more surgeons than I do.
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“Other times it’s because we train enough only to see them head overseas (in part, usually, to be able to repay student loans faster – what a great policy that is!)”
Could someone please tell me who in their right mind wants to pay off their interest free student loan faster? I certainly wouldn’t; given that inflation is supposed to be between 1 and 3 percent, it is a negative real interest rate of between 1 and 3 percent.
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Two reasons: (1) To eliminate the debt. It is a subjective burdon, and it can interfere with getting more debt (a mortgage for example) (2) To stop the 10% extra tax, thus having more income on a short term basis.
Simple really. Maybe it does not fit “rational agents” theory of how certain economists residing in ivory towers think people should act. But we should all be used to them being completely wrong!
peace
W
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Every year I live my life expectancy goes up by four months.
Can we actually be poisoning ourselves or are we in fact the best fed, healthiest, longest lived, safest generation that has ever lived.
When we first introduced the universal pension only 15% of adult males lived long enough to collect it.
Are we sure we are suffering from bad food and bad medicine?
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That’s assuming that past trends continue though Owen. I thought there was a worry that future generations might actually end up having lower life expectancies due to issues like obesity, diabetes etc. etc.
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