by Kevin Hague
While the Government intends to increase DHB contracting with the private sector, we should instead first assess what capacity we have in the public sector; with proper logistics planning the public hospitals can do more work.
Neither the Minister of Health nor the Ministry of Health has been able, under questioning at the Health Select Committee, to say how well the current operating theatres in New Zealand’s public hospitals are being utilised. For that reason I have written directly to all DHBs to ask.
I am aware, from my own experience as chief executive of a DHB and familiarity with many hospitals around the country, that many of these operating theatres stand unused for significant amounts of time. For example, they’re almost all unused at weekends; most hospitals would have at least one theatre “on standby” to deal with emergencies; and often theatres aren’t being used because there are insufficient staff in key roles, or because the staff and the patients aren’t both available at the same time that the theatre is free. It seems to me that we should have considered this information before Mr. Ryall committed to building another 20 operating theatres around the country and funding the private sector to deliver more surgery.
The practical effect of the change will be an increase in the uptake of private health insurance, representing a significant rollback of the Government in funding healthcare.
Of course it is legitimate to debate how much of the cost of healthcare should be shouldered by the State, and how much by you and me personally. But Health Minister Tony Ryall has not bothered with such debate, instead opting to substantially shift these costs without hearing others views.
This year’s Budget, while providing for increased Health costs in the current year, signals intent to decrease spending in future years. For those people who have been paying attention, this will have struck an ominous chord, as the need for health services continues to increase, and indeed to accelerate, due to an aging population, development of new (and more expensive) ways to treat, and epidemics of long term conditions such as diabetes and heart disease.
One way of managing the increasing need is to increase investment in programmes aimed at improving health in the long term. That is clearly not the Government’s strategy, as it has instead chosen to take the axe to exactly such programmes. For example, the substantial investment in Healthy Eating, Healthy Activity programmes by the previous Government has been decimated by the new regime. There is no evidence to support this decision; it is purely ideological. Unfortunately these were programmes aimed at producing gains in the long term, and their loss won’t be felt until well beyond the tenure of this Government.
At the same time, it has become apparent that Government instead plans to deal with the problem of increasing demand for health services by making more of us take out private health insurance.
Government has put pressure on district health boards to contract out more surgery to the private sector, as if this will enable the overall system to produce more operations. However, there is a fixed number of professionals in the system, and the Government’s decision won’t create any more – it will simply shift professionals from the public system to the private sector (where pay rates are substantially better). There isn’t a bunch of surgeons, anaesthetists and members of theatre teams standing around idle in the private sector waiting to do more.
This approach will further reduce the capacity of public hospitals, creating more and more hole, and increasing reliance on the private sector. Some cost in the public sector will fall although not as much as Government might think, as many of the costs are sunk in underutilised buildings and equipment. Just enough however to enable the Government to meet its promises of decreased expenditure, while more and more of us are forced to take out private health insurance and thus perpetuate a vicious spiral.
Of course there is another theory: Tony Ryall doesn’t understand the system well enough to realise the consequences of his decisions. Perhaps there is not yet evidence to support this theory, but when the Surgical Hospitals Association presented to the Health Select Committee recently calling for more public contracting to private hospitals, and more Government encouragement for people to take out private health insurance, was some kind of debt was being called in? Certainly this would explain the Budget.
There is no doubt that it will be more and more challenging for the sector to meet the increasing need for elective surgery. But there is another way: no attempt has been made to match up people in need and specialist skills against our existing theatre capacity. Instead the system is saddled with the inefficiency of 21 separate queues. With collaboration, we could extract more efficiencies from the publicly-provided health sector in New Zealand before we give up and shove the cost burden back on to individual citizens.
Published in Environment & Resource Management by Kevin Hague on Sat, July 25th, 2009
Tags: contracting out, DHB, health, Kevin Hague, privatisation
More posts by Kevin Hague | more about Kevin Hague
on the trolls and those who are unable to keep on topic
- “we should instead first assess what capacity we have in the public sector; with proper logistics planning the public hospitals can do more work….With collaboration, we could extract more efficiencies from the publicly-provided health sector”
As honest an admission of failure as you’ll ever hear from a statist.
If a decade of control by a committed Labour/Green government isn’t sufficient to implement such fundamentals as “proper logistical planning” it is indeed time to look at a different model.
- “we could extract more efficiencies from the publicly-provided health sector in New Zealand before we give up and shove the cost burden back on to individual citizens.”
It’s a shame that the Labour/Green didn’t think about the “cost burden” on us “individual citizens” during its decade in power, in which by your own admission it failed to implement even basic efficiency measures.
You had your chance to demonstrate that a monopoly service provider can be efficient. You failed. Calls now to “extract more efficiencies from the publicly-provided health sector” are simply taking the p***.
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Great rant, wat, but easy when you don’t know what you’re talking about. The Greens had little, if any involvement with the health policy of the Labour govt, just as we have little involvement with the Nats in this area. Kevin was very critical of Labour when he was at the DHB and this piece could just as easily be directed at them.
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What Labour/Green government are you talking about?
respectfully
BJ
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What “monopoly service provider”? Isn’t Kevin’s point that the service is currently provided by 21 different providers?
Trevor.
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Valis,
Ah, the old leftist canard excusing all their central-planning fiascos: “Everything would have been fine if the right people (read “our people”) had been making the decisions.”
Of course, the people who actually get themselves into these decision-making positions are not objective, selfless aesthetes concerned only with some supposed “greater good”; rather they are grubby, self-interested political animals, skilled at rhetoric, pole-climbing and TV photo opportunities, and with a keen understanding of how to use other people’s money to bribe key constituent groups to further their advancement.
Hence, when you say that “The Greens had little, if any involvement with the health policy of the Labour govt…Kevin was very critical of Labour when he was at the DHB “, you are really conceding my point.
How many years must healthcare remain inefficient until your brilliant candidate finally gets the job as health czar (if he ever does)? And what happens when he leaves?
By contrast, the pressure for efficient execution and delivery in a free market is constant.
Secondly, the concept of central-planning is itself inherently fatally flawed because, without a free-market to discover prices, even Saint Obama himself could not make efficient planning decisions.
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Hey wat
Always enjoy your posts. Have you any reading recommendations for me? Hayek, I assume? Austrian school?
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Likewise good to see you doing the Lord’s work BP.
It’s mostly blogs for me now. Cafe Hayek and Econlib are great, and have good blogrolls to other stuff.
http://www.cafehayek.com
econlog.econlib.org
http://www.marginalrevolution.com
For entertainment, some of the British swearbloggers are very inventive in tearing politicians and Guardian readers a new one:
devilskitchen.me.uk
obotheclown.blogspot.com
bastardoldholborn.blogspot.com
mreugenides.blogspot.com
http://www.samizdata.net/blog
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Ah, the old leftist canard excusing all their central-planning fiascos: “Everything would have been fine if the right people (read “our people”) had been making the decisions.”
So you need to change the subject from “Labour/Greens stuffed it up when they had the chance”, to “Greens would have stuffed it up anyway”. Whatever.
Hence, when you say that “The Greens had little, if any involvement with the health policy of the Labour govt…Kevin was very critical of Labour when he was at the DHB “, you are really conceding my point.
Lol.
How many years must healthcare remain inefficient until your brilliant candidate finally gets the job as health czar (if he ever does)? And what happens when he leaves?
Ryall is going to build new theatres and shift operations to private providers when there is spare capacity in the current system that has already been paid for. That’s not going to be more efficient.
By contrast, the pressure for efficient execution and delivery in a free market is constant.
Please let us know a country that has this system, so we can read about how wonderful it is.
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Many thanks, Wat. I’ll add them to my list
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No worries, once all the fat is cut out, there will be increased service levels for far decreased cost.
Don’t worry, the redundant paper pushers will get a job at McDonalds.
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Valis,
“By contrast, the pressure for efficient execution and delivery in a free market is constant.
Please let us know a country that has this system, so we can read about how wonderful it is.”
It’s here and now, all around you: our standard of living is amazing; nothing short of a miracle. It is indeed “wonderful.”
The one drawback of the collapse of Communism was that the stark demonstration it offered of the economic superiority of free markets over central planning, and of the deleterious effects of state-sector monopoly, collapsed with it.
Even if you insist of universal health coverage for Kiwis, that is no reason for actual service delivery to be a monopoly state responsibility. The more you can harness the free market, the more efficient the service will be and the more healthcare you get for any given budget.
Unfortunately, leftists want to directly control stuff and make those big decisions affecting everyone else’s lives. They get off on it.
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It’s here and now, all around you: our standard of living is amazing; nothing short of a miracle. It is indeed “wonderful.”
We’re talking about provision of health care, wat.
The one drawback of the collapse of Communism was that the stark demonstration it offered of the economic superiority of free markets over central planning, and of the deleterious effects of state-sector monopoly, collapsed with it.
No argument with the woes of Communism. And there’s nothing in Kevin’s post that would make any normal person even raise it as an issue.
Even if you insist of universal health coverage for Kiwis, that is no reason for actual service delivery to be a monopoly state responsibility. The more you can harness the free market, the more efficient the service will be and the more healthcare you get for any given budget.
Please let us know a country that has this more pure system, so we can read about how wonderful it is.
Unfortunately, leftists want to directly control stuff and make those big decisions affecting everyone else’s lives. They get off on it.
Yes, its all about us. Be careful, we hide behind trees and under beds too.
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Literally just came upon this from Bill Maher at http://www.huffingtonpost.com/bill-maher/new-rule-not-everything-i_b_244050.html
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Wat
We don’t often agree on anything but this….
Even if you insist of universal health coverage for Kiwis, that is no reason for actual service delivery to be a monopoly state responsibility.
… seems to be an exception. The state doesn’t have to be the monopoly provider of health services.
Of course it is not entirely that in the current environment.
My medical group is not a group of employees of the government.
The government does however have the big hospitals. One can question if such things could/would be built here without the government. The words “market failure” have nasty impications when applied to the provision of health resources in small isolated communities, yet there is scope for considering privatization.
The state does not HAVE to be the monopoly provider of health services.
Of course, the issue of what part of government the Green party actually was over the past decade is still unanswered by you. You continue lumbering us with failures of Labour, Winston-First, and Peter-overDunne.
Most people actually know enough NZ history to know this is a false argument on your part.
BJ
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Interesting Q&A
Jeanette, Simon Upton, Nick Smith and the woman who put her name to the referendum!
Jeanette opens with a clear description of National’s latest moves to sell off NZ’s assets.
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15%
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Interesting debate. Thank God we’ve got National in government.
Janette – typical spend, spend, spend money we don’t have. Drive some pissy little car.
Nick Smith – we’ll do what we can realistically achieve. No magic bullet for agriculture. Other countries have lower costs for reductions, so we can’t lead.
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No magic bullet for agriculture? Good God, I thought there was! Thank you Nick, thank you Blue, for clearing up that popular misconception! It’s full steam ahead and damn the torpedoes! And quite right Blue, Jeanette’s suggestion that we could reduce our transport emissions by 50% for starters – another ridiculous Green claim – preposterous! You’ll not catch Smith in some ‘pissy little car’ (though he does drive an electric car, but it’s National Party approved, so it’s not ‘pissy’) What have we been thinking??? Anyway, if it all turns to custard, according to Nick Smith, it’s only those living on beach front properties that will be inconvenienced. That’s such a relief.
j
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Is there a link to the content of the interview?
BJ
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You’ll easier nail one of those to a tree than keep BP from muttering… and no the damned book still hasn’t showed up!!!
BJ
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At the public consultation meetings, Nick Smith said that his and his government’s decision was going to be based on the science, on the science alone.
Cr*p.
The degree to which the National Party move on this will be entirely based upon what they believe they can get away with on the international stage – that is, the minimum required to avoid trade sanctions against our country.
bj – if you use enough nails…
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bj – it’s a watch, not a transcript
http://tvnz.co.nz/q-and-a-news
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Glad to see the 40% ers failed.
New Zealand should do the least possible in order to participate, as our only goal is to avoid trade sanctions. Our level of emissions simply doesn’t make a difference. The biggest cuts should be made by the countries polluting the most – per country. Per capita is meaningless (think China)
That is the science. That is the political reality.
Well done, Nick Smith.
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That was an interesting interview. I’m glad that the “cost of not doing anything” was brought up as it often seems to be ignored. Why aren’t we saying that it’s a choice between $15 billion to do it and $xx billion not to do anything. Why does it seem like the choice is between spending money to avert climate change and not having any economic cost from doing nothing.
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jarbury
The ‘cost of doing nothing’ was quickly rendered down to the trade sanctions issue. Discussions about the ‘greater environment’; species extinctions, changing ecological zones, the loss of food growing areas etc. weren’t even mentioned. I found that most significant of all. It’s as though those macro issues aren’t even in the frame. Its the same level that Bluepeter views the issue from – the height of a tetering stack of bills.
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What is our current imported fuel bill (oil, LPG, etc)? And more importantly, what will our imported fuel bill be likely to rise to if we do nothing. That is just part of the real cost of doing nothing – billions of dollars per year going overseas – if we are lucky. We could find ourselves unable to import much oil or LPG at all at any price if the people who actually hold any want it themselves and don’t want to sell.
Many of the measures to reduce our CO2 emissions are also measures to reduce our oil and LPG imports, including saving more of our local natural gas for transport rather than electricity generation or heating.
Trevor.
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Valis,
- “Please let us know a country that has this more pure system, so we can read about how wonderful it is.”
Singapore is often cited as an effective model:
http://econlog.econlib.org/archives/2008/01/singapores_heal.html
Incidentally, that page references this other one, which has some very interesting things to say:
http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/
But let’s be honest, we could devise the most cost-effective scheme in the world and it wouldn’t make any difference because the Labour Party here (as in the UK) is the political arm of the state sector unions.
It is run for their benefit, not ours. Labour is keen to expand the size of the state sector at any price, because it knows it is buying votes. It is ruinous but legal gerrymandering on a grand scale.
In the UK, Gordon Brown doubled spending on an unreformed state health service, while at the same time productivity actually declined by some 10%. And the UK has an unfunded pension liability for state employees of 1 trillion pounds.
Even without the decision to bail out the banks, UK government spending was on a wholly unsustainable trajectory as it spent more and more on a state sector becoming less and less productive:
http://www.marketoracle.co.uk/Article11247.html
So you have precisely two choices:
1) Reform NZ’s health sector now to make delivery largely a private sector responsibility
2) Introduce these reforms in 20 years in the face of imminent bankruptcy after following Britain’s example of throwing money at the state sector.
There are no are options.
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Trevor29,
- “That is just part of the real cost of doing nothing – billions of dollars per year going overseas”
What difference does it make to you where the oil comes from? You personally would still have to pay for it even if it came from somewhere in NZ. The fact that you have the option of buying cheaper oil from places with lower production costs is a benefit.
Remember, imports are good: it is the division of labour, coupled with free trade, which makes us so wealthy.
- “We could find ourselves unable to import much oil or LPG at all at any price if the people who actually hold any want it themselves and don’t want to sell.”
That’s a big and very fanciful “if”, but one that you are free to act upon if you wish. However, I think after a few weeks with a horse and cart you might have a rethink.
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wat,
I am acting on that belief. I have deliberately chosen not to use either LPG water heating or an LPG fire in the new house I am constructing (in the South Island, where we don’t have access to natural gas).
You are the one living in fantasy land if you believe that there is an unlimited supply of oil and LPG. Those of us who look at the real world realise that sooner or later the oil and LPG supply will drop below the demand and prices will climb. The countries that will do best are those that move away from high consumption of these fuels and move towards more renewables.
If we don’t act, we may be faced with a horse and cart future. If we do act, we may face a future with battery powered electric vehicles charged from wind, wave, tidal, solar, geothermal and hydro power. I know which I would prefer.
Trevor.
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Trevor
I’m enjoying your comments. Have you seen any reference to compressed-air-powered trains? Just talking around the fire here, we’ve discussed wind-mill compresion of air to tanks that sit on ‘trucks’ behind the engine and drive the train to the next windmill. How clean is that?
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Trevor29,
No one’s arguing that alternative energy sources won’t become economically viable as technology improves and deposits of oil and gas become depleted.
The questions are when that will happen, and whether we should let ideologically fixated politicians distort the market with subsidies and incentives and try to pick winners from the range of developing technologies.
A level playing field is all I ask for.
The UK, by the way, is facing an entirely self-inflicted energy crunch in just a few years because politicians, having made it a political issue, then failed to make the tough decisions.
So your decision to forego LPG in your new house may be a wise one; by which I mean politically astute rather than being based on geological reality:
“Huge new fields also have been found in Texas, Arkansas and Pennsylvania. One industry-backed study estimates the U.S. has more than 2,200 trillion cubic feet of gas waiting to be pumped, enough to satisfy nearly 100 years of current U.S. natural-gas demand.”
http://online.wsj.com/article/SB124104549891270585.html#printMode
Incidentally, since Greens are known for their support of the intrusive and burdonsome RMA, there was a delightful case of equivalent legislation blowing up in their faces recently in the UK:
“Vestas, a Danish company which is the world’s biggest wind energy group, announced in April it was pulling out of the UK, citing the difficulties of getting wind farms built in Britain in the face of local “Nimby” opposition campaigns and the slowness of the planning system.”
http://www.independent.co.uk/environment/green-living/wind-power-plan-blown-off-course-1757467.html
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wat – without the ‘nimby’ legislation you decry, how would you deal with the construction of something nearby to you, that you didn’t want to be built. Say, a bag-pipes testing station.
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greenfly,
This is what the Coase Theorem deals with: http://en.wikipedia.org/wiki/Coase_theorem
In this case, the windfarm company should be able to offer to pay an amount to nearby residents to make up for any externalities. If the residents ask too much, the company will have to try for a different, perhaps less suitable, site. If they can’t find anywhere, then presumably wind power is not an economic prospect once you take into account its externalities.
Also, I would argue that the price we pay for our houses reflects the fact that we know a bag-pipes testing station can’t be set up next door.
If there was no such legislation, the risk of ownership would be much higher and therefore we would pay less for the house. Many more of us would choose to rent instead.
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Wat – soooo… in the case of a bag-pipe testing station setting up near you at this time, (you didn’t know it was coming, did you) you would.. run away? Rent somewhere else? Is that it? Given that you own your house (you may do) and that you paid a high price for it (as you imply) are you saying that the rich are happy to dispose of the RMA because they are sitting sweet in their expensive houses? They are safe from the annoyances of the likes of the BP testing facility because they have paid for the privelige? I’m begining to get fix on where you are coming from wat. No wonder you were reluctant to send me your bank account details.
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# wat dabney Says:
July 26th, 2009 at 4:07 pm
> Also, I would argue that the price we pay for our houses reflects the fact that we know a bag-pipes testing station can’t be set up next door.
> If there was no such legislation, the risk of ownership would be much higher and therefore we would pay less for the house. Many more of us would choose to rent instead.
which I presume is Wat’s idea of the market solving a problem. Only trouble is, it wouldn’t solve the problem – it wouldn’t actually reduce the amount of noise pollution from bagpipe-testing stations, or the number of houses affected by it.
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There are no are (sic) options.
Of course not for someone who sees only black and white. The rest of us are sure we heard the same line 20 years ago and yet it seems we have another 20.
At any rate, the issue was about better utilising the theatre assets we already have. I can still see no reason not to do so.
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greenfly,
It’s a matter of property rights and legitimate expectations.
I believe it is well established that loud noise constitutes a negative externality, so your blessed bag-pipe testing station’s noise is no different from a vehicle testing station pouring its used oil over the fence onto my land.
On the other hand, if the church next door changes from one denomination to another, it is not in law a legitimate expectation for me to consider that a negative externality, even if I think they are the spawn of Satan. And I would have known this when I bought the property, and would have valued it accordingly.
Planning laws favour existing property owners at the expense of everyone else, but the particular fault with the RMA is that is stops people doing what they want with their own land even when there are no externalities, such as cutting down their own trees etc.
Valis.
- “At any rate, the issue was about better utilising the theatre assets we already have. I can still see no reason not to do so.”
Except…they haven’t been better utilised, have they. After a decade of a government which firmly backs the idea of state provision of healthcare, these theatres are still idle much of the time.
A private company that was so inefficient would have failed years ago and the resources allocated to a company with better ideas and better management.
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greenfly,
I haven’t seen any technological discussions of compressed-air powered trains and I doubt that their efficiency would make them economical. Diesel-electric locomotives are standard technology, as are all-electric locos. Gas turbines have been used for electricity generation for ages. Battery powered electric vehicles are also maturing, but still suffer from size and weight issues of the battery packs. However size and weight is less of a consideration on a train than a road vehicle.
Put this all together and the result might be electric locos with battery packs that can allow them to run between sections of electrified line, and which can recharge from those electrified sections.
Alternatively we might see locos which can run on electrified tracks but also with gas-turbine generators that could use a range of fuels for sections of track which are not electrified. These may or may not also have battery packs to smooth the demand on the gas turbines.
Of course the most efficient solution is to electrify all the tracks but this could be a problem over the Southern Alps.
Trevor.
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wat – natural gas is not LPG. Natural gas is methane. If it is compressed it is called CNG (Compressed Natural Gas). If it is liquified by cooling to very low temperatures it becomes LNG (Liquified Natural Gas), but it is still methane.
LPG is Liquified Petroleum Gas, which is compressed propane and butane. Methane is CH4. Propane is C3H8 and butane is C4H10, so LPG is significantly different to natural gas. New Zealand imports LPG. We don’t currently trade natural gas, nor do we have the facilities to do so.
Trevor.
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A significant difference between rail and other sorts of transport is that rail engines are designed to be heavy. A gas turbine is significantly lighter than a diesel of equivalent power, but if placed on a locomotive it will spin its wheels, and it will be unable to pull the same load as the heavier diesel.
“We could find ourselves unable to import much oil or LPG at all at any price if the people who actually hold any want it themselves and don’t want to sell.”
That’s a big and very fanciful “if”, but one that you are free to act upon if you wish. However, I think after a few weeks with a horse and cart you might have a rethink.
Wat – There isn’t a single one of us advocating going back to horses and carts here. Which makes your comment, like so many others of your comments, a little bit of nonsense tacked on. Even if we can’t import oil and LPG we CAN create CNG and LNG and use it as a fuel. We CAN build electric cars and use electric trains. We can manage the problem if we recognize that there is a problem coming.
Now if you expect that the energy problems of the planet are solved, that peak-oil hasn’t already happened and business-as-usual can continue apace, you are going to be disappointed. The “if” postulated isn’t extravagant at all. Oil prices will respond to the economic failures and I expect we are not finished with those, but there will not ever be as much oil pumped as we pumped in 2005.
The ability to transport natural gas across oceans is limited, and other bidders for the fuel have more money than we do. The idea that we might be outbid for the scant shipping capacity (given the absence of any LNG port here in NZ) and that it might prove an expensive way for us to adapt, seems much less extravagant than the idea that our problems are over.
BJ
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BJ,
As any ute owner will tell you, to get better traction on the rear end, drop some bags of sand or cement in the tray. same with a loco, add weight.
Additionally you could increase the number of axles. You could quite easily have a front unit locomotive with the gas turbine unit and electric drive , plus one or two slugs with electric drives only (with added ballast to give traction). Making 18 axles in total.
The gas turbine generating enough electricity for all three units. Something a diesel is not good at.
Slight correction, we do ave an LPG terminal port in New Zealand. Situated in the Manukau Harbour just off the airport. Only good for coastal shipping, though thinking about it, I havent seen a ship there for a long time.
Good fishing around it but. And situated in an excellent bit of water for sailing (when the tide is in).
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bj – trevor says (of compressed-air trains),
I haven’t seen any technological discussions of compressed-air powered trains and I doubt that their efficiency would make them economical.
and you (of a gas turbine)
but if placed on a locomotive it will spin its wheels, and it will be unable to pull the same load as the heavier diesel.
Are you refering to compressed air driven engine there also? I’m not getting any answers that I can get my teeth into. Is the idea a vapour?
Gerrit’s idea seems more down the track I am exploring (and he seems to know his trains)
Is a compressed air engine pulling a train even a possibility? It appeals to me because the filling stations would have a limitless supply of very, very cheap energy. Windmills compressing air – as much as you might desire. Good time to buy the tanks is now.
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The weight problem of a gas-turbine electric loco is easily solved – just add batteries!
The only reason I am even suggesting a gas turbine is that we have natural gas available, and we can produce methane from wastes.
greenfly – compressed air heats up as it is compressed. This heat is lost (although it can be captured and do a bit of good at the site it is being compressed). When you let compressed air out, it cools, reducing its pressure. It is quite difficult to capture most of the energy available from the air in a compressed air cylinder. The result is quite a poor efficiency overall. Using batteries to store the energy in a form in which it is available (through electrified sections of track) and for which trains are already designed and built to use makes more sense to me.
Trevor.
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Gerrit – the shipping terminal you refer to handles LPG, which is a mix of propane and butane. LPG can be held in a liquified state through pressure alone. Natural gas is methane and can be held in pressurised tanks in which case it is CNG, or it can be liquified by cooling, in which case it is LNG but it cannot be liquified by pressure alone. New Zealand is not set up to import or export LNG, and it is not considered practical to ship natural gas in the form on CNG. We do import LPG – I know this personally because my LPG supplier put the price up because overseas LPG prices had risen and they imported the stuff.
Trevor.
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Trevor – thanks and pardon my banging on about compressed air, but..
does it matter if efficiency is poor, if the resource is all but free? Do you mean it would drive poorly?
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greenfly – the resource – compressed air – is not free. You are suggesting wind farms to compress the air, but this would be as expensive as the wind farms that generate electricity. In addition, electricity is easier to move longer distances over existing infrastructure. The compressed air would need to be produced by the rail lines, which are routed where it is as flat as possible. The best positions for wind farms is on ridges where the wind speed is highest. Therefore you have two conflicting requirements. There is also the problem of powering the trains when the wind isn’t blowing, which can be for a week or more.
Compressed air storage is being seriously considered, but more for utility-scale storage in old mines, etc.
Trevor.
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> – “At any rate, the issue was about better utilising the theatre assets we already have. I can still see no reason not to do so.”
> Except…they haven’t been better utilised, have they. After a decade of a government which firmly backs the idea of state provision of healthcare, these theatres are still idle much of the time.
Interesting, Wat takes the fact that the theatres haven’t been utilised better so far to argue against a minor administrative change to get around the problems that have prevented them from being better utilised. What is logic like on planet Wat Dabney?
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And in reply….
http://www.macdoctor.co.nz/2009/07/26/the-problem-of-capacity/
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wat dabney Says:
July 26th, 2009 at 12:37 pm
> Singapore is often cited as an effective model: (for health care)
> http://econlog.econlib.org/archives/2008/01/singapores_heal.html
It’s also worth reading the comments in response to that article. There they note that Singapore has a younger population than most OECD countries, which leads to lower health care costs per capita. They also point out that people with serious health problems are missing out on treatment in Singapore. Because this would be a relatively small number of people in need of realtively expensive care, it would reduce the cost significantly without reducing average life expectancy by much. But it is not a saving through greater efficiency – it is a saving through reduced provision of health care.
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Sorry
Wasn’t talking to the compressed air issue directly. Compressed air has stuff-all energy density. Needs to be VERY compressed or needs very very large tanks. Very energy expensive to stop trains to recharge. Damned hard to replenish compressed air without stopping.
Wasn’t saying anything against the use of the gas-turbines either. Has been done in many places. They aren’t common here though. We don’t value their strengths so well (speed), and the rail system is not well prepared for the complexity.
The reason compressed air power can work in any vehicle is if the vehicle is lightweight and/or can get recharged frequently, and the big breakthrough for the French and Indian companies involved in the automotive arena was the lightweight motor.
Recharging a compressed air system is fast enough if you can provide volume at double the working pressure of the system itself. It is very very fast then… and any water vapor in the air freezes solid.
Not a good thing. Except that as a solid it is little easier to remove. Provided the solidification is controlled.
Electricity can be recharged/supplied through a long sliding contact. Well understood tech, easier to implement.
There are gas-turbine systems. There is also a steam-turbine system which could be fired by wood pellets if we wanted. The advantages of the generator-slug systems aren’t that apparent unless you are trying to haul longer trains longer distances (or need to tighten your curves and use shorter units).
respectfully
BJ
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I think that what Kevin is saying makes a lot of common sense by simply evaluating what a hospital has that can be utilised before relying on out-source private firms that will be charging a profit that a public organisation can avoid.
I would like to see hospitals and local bodies disconnect with private operators and build their own infrastructure. Eg. like works departments for councils and dental departments for hospitals.
When local bodies worked on this model our rates were a lot more reasonable even though there were badly run and in effecient departments.
This proves that ACT’s ex-minister Richard Prebble was talking a load of complete sophestry in his book “I’ve Been Thinking” (evidence of which is very doubtful).
He based that whole book on his brief sojourn at the NZ Railways.
Yes it was badly run down but was the navy. army or airforce badly run down?
He was using the railways as an isolated precedent which presented a badly flawed argument!!!!!
ACT will be trying to use the same sort of half baked logic to justify the flogging off of our potentially efficient hospital system.
Cheers
Drak.
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The private sector and competitive market forces, not the federal government, are the best means to meeting our country’s rapidly expanding health care needs. One of the things I think we can do to help make that happen is support American businesses and the U.S. Chamber of Commerce (http://bit.ly/oanAT). They’re doing things to reach out and show people that they can get involved, too.
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Whether our needs are met or not is one issue. How we are insured against those needs is a different issue. It is vastly LESS efficient to base the funding of care on private insurance than on a public and universal scheme.
Unless you have been in a US clinic, in some administrative staff outnumber the caregivers by roughly 2 to 1 in order to cope with all the different insurance companies with their care-denial schemes, you will not truly understand the danger posed by the private sector in this.
Whatever the “Friends of the US Chamber of Congress” is on about, their petition doesn’t actually do anything. In terms of health they ask for “Providing access to quality, affordable health care… “
This bit is window dressing. They are trying to get people to sign a petition “Supporting the right of workers to choose whether they want to join or quit a union.”
…which is to say, they want the surviving unions gutted.
respectfully
BJ
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This is what you don’t see here – but it is real when privatization works its magic.
http://www.guardian.co.uk/world/2009/jul/26/us-healthcare-obama-barack-change
This in a country that spends 50% more per person than other countries.
BJ
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I think private sector are competitive market, just let they try than we can analize how the result.
mancing
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Always entertaining, watching folks who clearly know nothing about health care putting the world to rights.
For a general hospital, that is one that has a mix of scheduled and non-scheduled work, effectiveness and efficiency are opposites, and improving one is at the cost of the other.
If you go back a few decades patients did not get their operations cancelled on the morning of the op, corridors did not have rows of patients in beds in them, and when I was on-call I could usually find a fully empty ward to snore in. Nurses didn’t have to spend hours on the phone trying to find a bed These bad features are with us now because there is not the slack in the system that there used to be. Sure hospitals used to be really inefficient, but efficiency has improved dramatically over a few decades. Now there is a lot less slack in the system the slightest hitch causes all kinds of problems.
Of course, a typical private surgery hospital doesn’t have an A&E unit to introduce disruption, and they dont welcome stragglers at the door. And they generally take on more routine work (ie more schedule-able), so you can run a more efficient ship. There is no reason why public hospitals (without A&E) couldn’t work that way too, other than the perception that people have that if they’re ill they can just turn up at a hospital and someone will help them out. And they will. And there goes the efficiency.
The other thing that amuses me constantly is paper pushers. Yes all hospitals are full of paper pushers but that is because health services are paper intensive businesses almost all paper pushers are working on paper directly related to patient care. Sure, you could sack the paper pushers, and what happens then? Once there are no medical secretaries and no filing staff then who pushes the paper? Yep, the front line staff, who then find they have less time then ever to undertake what they are paid for…
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# dbuckley Says:
July 29th, 2009 at 4:40 pm
>Of course, a typical private surgery hospital doesn’t have an A&E unit to introduce disruption, and they dont welcome stragglers at the door. And they generally take on more routine work (ie more schedule-able), so you can run a more efficient ship. There is no reason why public hospitals (without A&E) couldn’t work that way too, other than the perception that people have that if they’re ill they can just turn up at a hospital and someone will help them out.
and the fact that that would mean the emergency cases would have to be dealt with by other hospitals; and the hospitals that deal with the emergency cases would run even more inefficiently, because they wouldn’t have elective surgery to do when there weren’t as many emergencies, so their operating theatres would be left empty even more of the time.
Another factor accounting for cost differences between public and private hospitals is the fact that public hospitals train junior doctors. This gives them the service of those junior doctors cheaply, but it also means that they actually have more doctors on for an operation. If we had no pblic hospitals, the junior doctors would have to do their apprenticeships in private hospitals, making the private hospitals less efficient.
> Sure, you could sack the paper pushers, and what happens then? Once there are no medical secretaries and no filing staff then who pushes the paper? Yep, the front line staff, who then find they have less time then ever to undertake what they are paid for…
I once had to wait an extra one and a half hours for a hospital specialist appointment, because they were waiting for an orderly to bring my medical notes from the department that had had them last – which is a clear if somewhat farcical example of inefficiency caused by lack of administrative backup (incidentally, I offered to go and collect the medical notes myself, but apparently the regulations don’t allow it).
Another time, I missed an appointment because the secretary left me an answerphone message saying my appointment had been shifted to the 12th of February, when the correct date was actually the 12th of January. I don’t know if that mistake can be blamed on lack of administrative staff, but it is an example of a doctor’s time being wasted due to bad administration.
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I don’t hear much controversey over the Cuban health system!!!!
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