by Kevin Hague
Sometimes the House is frustrating. I succeeded in my bid for a question today, but when we have two primary questions in a day we don’t get any more supplementary questions added to us. My boss had question 2 and mine was 11 and, since the Gallery journalists start drifting off after about 5 questions, he got 4 supplementaries and I got 2.
It was the right thing to do but, oh how frustrating! Two just wasn’t enough to get below the superficial answers Ministers typically begin with and so it proved today.
Last month I asked Tony Ryall a series of questions about inequality and New Zealand’s woeful record on child health. The evidence is really clear that poor child health status is strongly connected to the wide and widening gaps in socioeconomic status in New Zealand. One of the areas I focused on was rheumatic fever. Rheumatic fever is a disease rarely seen in most developed countries. It starts as a strep sore throat and can end up with damaged heart muscle and the need for surgery. It is the classic indicator disease for links with inequality: poverty and overcrowding are the risk environments for rheumatic fever, while unequal access to primary care means that those with early stage disease don’t end up being treated with antibiotics early enough.
New Zealand has the worst rates for rheumatic fever in the OECD, at 14 times the OECD average. This is truly a national disgrace. I asked the Minister what his Government has been doing to tackle rheumatic fever. He really didn’t seem to have any idea. To his credit he mentioned the Green party’s home insulation policy that the Government has been implementing, but other than that it was something vague about reorganising primary care, and childhood immunisation (for the record: there is no immunisation programme for rheumatic fever).
So following the exasperated statements of cardiologist Nigel Wilson this week about how fed up he was having his time taken up with a disease that is entirely preventable (and has been entirely prevented in other developed countries) I asked the Minister about the cost of rheumatic fever to New Zealand. Even though Tony Ryall was in the House today, he transferred the question to Associate-Minister of Health Tariana Turia. Which I thought was interesting!
Alas minister Turia didn’t seem to know much about the cost to New Zealand (but knew something, and all the Minister has to do is “address” the question). My follow up was to ask whether she thought the plan set out by Tony Ryall was adequate, and if not, whether other measures had been added to it. She didn’t answer that one at all, but I didn’t argue convincingly enough to the Speaker to make her do so. Then my second supplementary asked what her Government was doing about poverty and overcrowding. Apparently the Government is making its departments talk to each other. Well that’s better than nothing at all I suppose. Children with rheumatic fever will no doubt be celebrating .
Published in Featured | Health & Wellbeing by Kevin Hague on Thu, July 29th, 2010
Tags: crowding, inequality, Kevin Hague, Nigel Wilson, poverty, Rheumatic fever, tariana turia
More posts by Kevin Hague | more about Kevin Hague
on the trolls and those who are unable to keep on topic
the ‘disease of poverty’ is a powerful argument….
..and one gaining more traction most days…
…national are particularly vulnerable to a sustained attack on/using these grounds..
more power to ya..!
phil(whoar.co.nz)
Like or Dislike:
3 
1 (+2)
People see want they want – and the cushy Jobs don’t see poverty….they can have my job for a week and get a free(?)education.
Maybe I’ll hire buses come Election Day – I know where to locate the homeless people – lots of them…
Like or Dislike:
2 
1 (+1)
…find this interesting in terms of Who Said It.
“It’s a mistake to think that poor people get the benefit from the welfare system. It’s a total fraud.
Most welfare go to the rich of this country: the military-industrial complex, the bankers, the foreign dictators, it’s totally out of control.” Ron Paul – (1935-) American
physician, US Congressman
Course that’s the US he means eh?
Like or Dislike:
2 
0 (+2)
In 2008 UNICEF released data comparing OECD countries on their levels of child wellbeing and New Zealand did not come out well:
-Our children are more likely to live in low income households than most other OECD countries (rank 23rd).
-7% (1/14) of our children live in households where no parents are in employment (double the unemployment level at the time).
-20% of our children are in homes lacking in essential possessions that support a contemporary education.
-We are ranked 24th for child health and safety. Our levels of childhood deaths, due to accidents or abuse, are 20 points below the average and well below Croatia.
-40% of our children do not eat their main meal of the day with their family.
-Almost 50% of our 15 year olds are not able to have to have general conversations with their parents on a regular basis.
-30% of our teenagers become pregnant (rank 23rd).
-1/10 of our 15 year olds claim to feel a lack of self confidence in their normal environments.
And now it is revealed that our rheumatic fever rates are 14 times the OECD average and this is a disease directly related to poverty.
The only substantial thing the Government has brought in to address the issue of child poverty is ensure some homes are a little warmer, and we all know where that idea came from.
One can only conclude that this Government refuses to plan beyond the next election and the health and wellbeing of our children is a low priority. Our election advertising during the last election has even more relevance now!
Like or Dislike:
1 
1 (0)
So given 50% of our teens are male…that makes a 60% rate of pregnancy for teen girls! I don’t even believe the 30% rate. There were about 7000 teenager births out of about 70k total.
Obviously suspect numbers are just not helpful. AS for some of the other ones…well, sounds like normal teenage angst. They are almost laughable
Like or Dislike:
4 
0 (+4)
And socialism is the solution is it? Hasn’t worked anywhere else in creating wealth amoungst the poor….
Like or Dislike:
5 
7 (-2)
insider-Point taken, I think the real statistic is that we were ranked 23rd in terms of pregnancy rates amongst our teenagers out of 32 countries. I think it is always best to see statistics in the context of the whole study, but the point I was attempting to make was that where once New Zealand was world leading in child health and wellbeing we now sit well down the OECD list in most catagories. There are now 3rd world countries who care for their children better than us.
The most concerning areas for me are the high percetage of children living in low income households and being ranked 24th for our levels of child deaths through accidents and abuse. Kevin’s attempt to draw attention to the levels of rheumatic fever is just another example of how bad things have got.
Like or Dislike:
2 
1 (+1)
sprout says (or quotes)
“Our children are more likely to live in low income households than most other OECD countries (rank 23rd).”
About the same ranking as our income?
“7% (1/14) of our children live in households where no parents are in employment (double the unemployment level at the time).”
A sad indictment on our benefit and DPB system. While many parents who both work, can only afford to have two children, there are a lot on the DBP and benefits who seem to be able to afford to have far more than that.
“20% of our children are in homes lacking in essential possessions that support a contemporary education.”
Government fault or parents fault?
Ditto with things like eating with parents (or de we require the govt to pass the “Eating with your parents enforcement bill”?)
One area the govt should look at is the accident rate, though I wouldn’t be surprised if a large part of that is also due to really bad parenting.
Like or Dislike:
2 
3 (-1)
James said “And socialism is the solution is it? Hasn’t worked anywhere else in creating wealth amoungst the poor….”
No one said socialism was the solution. It would be interesting to hear what you define socialism as
aThe Government needs to be creating
wealthhealth amoungst thepooreveryone.Like or Dislike:
2 
2 (0)
Photonz1-Your suggestion that we have a higher level of poor parents in New Zealand than other OECD countries is interesting, as is your assumption that I was blaming the government for them.
It is undeniable that New Zealand has very questionable levels of child health and well being and we are dropping steadily down International rankings in this area. Whatever the causes for poverty, there is convincing research to show a correlation between inequities of income and higher levels of crime, poor health and lower levels of academic achievement (The Spirit Level by Wilkenson and Pickett).
I feel there are two important elements to this issue of child health and wellbeing:
1) Accept that New Zealand does have a significant problem in this area.
2) Determine the most effective ways of dealing with the issues.
This government does have a pattern in how they are responding to each crisis:
a) Rising levels of childhood obesity – Remove the need for healthy food in schools.
b) Early Childhood funding below the OECD average – Cut funding to centres with over 80% of qualified staff, only the wealthy will be able to afford the most qualified centres.
c) A high percentage of low income families – Actively block significant wage increases for those on the lowest incomes and give the largest benefits to higher income earners (thus increasing the disparities).
d) High levels of rheumatic fever amongst children, costing NZ $10 million a year – Get Govt departments to talk to each other.
e) A significant group of children underachieving academically-Sack curriculum advisors, keep teacher aids on minimum incomes and maintain their job insecurity (limits the ability to employ the best people or retain them), severly cut funding for the Ministry of Education then ensure all their time and money is spent implementing an asessment system that will provide information already available.
f) Many parents find it difficult to support their children due to long hours of work and inflexible leave-Tighten sick leave provisions, make holidays optional, remove ready access for union representation, allow poor employers to cut working conditions.
Photonz1- It’s not that I blame this Government for the current situation, I just don’t think they are doing anything effective to improve matters.
Like or Dislike:
3 
1 (+2)
sprout – you are cherry picking to get your pattern. Here’s what you’re missing.
- After the previous government stopped funding plunket line and just about killed it off, the current govt fully funded it.
- Vital pre-school checks which have been very successful, have increased six fold. They went from 11% of pre school kids being seen when the govt took power, to now reach over 60% of pre school children with stern instructions to DHBs to improve this further.
- New laws have been enacted to protect children more, with stiffer penalties for crimes against children. Also it is now an offence to do nothing when a child is being abused.
- Large increase in funding for childrens health camps for kids in foster care to get a holiday break (and so their carers get a break too).
- Massive fuunding injection for childrens dental care. Over $100m new capital spending including around 100 new mobile dental units and $40m per year operational spending
- Extend the highly successful Incredible Years programme which teaches parents to cope with difficult children. Previously 600 parents have done the programme, which will be increased to 12,000.
- There is also funding for an additional 5000 teachers to attend the programme (previously less than 200 had completed the course).
- More funding to detect and address hearing problems in young children, including a new nationwide screening programme to pick up problems from birth.
- new Kiwisport initiative with $80 million for get more kids involved in sports at schools and in clubs.
- additional $100+ million for early childhood education in 10/11, to a annual total of $1.3 billion (over three times the spending of $400 million five years ago). This new funding is targeted at poorer areas.
- New funding to provide food at school for an additional 7500 children (nearly doubled)
Of course there’s always more that can be done, but the facts show the situation is not the same as the one you are trying to paint.
Like or Dislike:
1 
1 (0)
Sorry Photonz1- What you have presented looks good but the reality is actually a little sad. For instance the money given to Kiwi sport will mainly go to clubs and support elite athletes and at the same time the National Government is cutting the funding for sports Co-ordinators in schools.
http://www.scoop.co.nz/stories/PA0908/S00151.htm
Additional funding to Early Childhood, do you mean returning what they took?
http://www.stuff.co.nz/marlborough-express/news/3909601/Anger-over-cuts-to-early-childhood-funding
New funding to provide food in schools for 7500 children and at the same time $4 million cut from the fruit in schools scheme.
http://www.scoop.co.nz/stories/PA0910/S00466.htm
I think you will find in most cases what is being put back in is less than what was taken out. When you add this to my previous comment things look even worse!
Like or Dislike:
2 
1 (+1)
sprout – you’re wrong on all counts.
The majority of Kiwisport ($45m) goes to schools.
The other $37m goes to clubs, schools and community groups for “SCHOOL AGED CHILDREN”
For early childhood, there is a $100m increase, and $900 million more per year than five years ago, and you show a story complaining of a $0.3m cut in one area. The increase in annual funding since 05 is 3000 times more than that.
You even completely misrepresent the fruit in schools story. The headline reads
“Fruit in schools future confirmed” The govt is extending the programe that was due to end. And to MORE schools.
The $4 million is is being saved from the rediculous $6 million dollars administration cost. (how come it used to cost as much for administration as it did for all the fruit?).
The $4 million saved from admin will be spent on other health services.
So we’ve got fruit in schools being extended both in time, and to more schools, with an administration saving of $4 MILLION, which will be spent on other health services, and you manage to spin that into a BAD story.
Like or Dislike:
4 
2 (+2)
Photonz1-It is hard to get beyond the spin, but this government is heavily focused on removing bureauracy and cutting funding but without the evidence it is really justified. The other aspect that defines this government is to come up with a vaguely realized scheme and then throw money at it without proper oversight that a certain level of bureauracy provides.
With the Kiwi Sport funding they have provided the funds but dismantled the established personnel who would manage and co-ordinate its use. With many schools operating on limited funding there is the real risk that the money may not be used appropriately. It is also more likely that the funding will be used to support elite sportspeople rather than focusing on the nonactive kids who are our future health risks. I know many schools spend more on their 1st fifteen Rugby team if it means recognition from the team’s success than fund a programme for a group of overweight, apathetic nonperformers, there needs to be a balance in the funding application.
With the fruit for schools, there very well may have been too much spent on administration, but that doesn’t fit with my experience. The distribution, organisation and co-ordination of the fruit to get it into every class is an involved process and when management becomes voluntary or reliant on good will it is likely to be dropped by schools.
Much has been made of the growth of the Education Ministry and the need to cut the claimed increase in bureaucracy. But the reality did not fit the rhetoric. Much of the growth was the assimilation of the Special Education staff into the Ministry and these are largely frontline specialists, advisors and itinerant teachers. The cuts were to encourage a focus on frontline services, but the opposite has happened. We no longer have curriculum advisors and much useful support for establishing our new curriculum was wiped when the focus shifted to the flawed National Standards.
With Early Childhood much was made of the huge growth in funding over the last five years, but this was due to the fact that it was seriously underfunded before. New Zealand is still well below the average funding for OECD countries. When the success of an education system is heavily reliant on the expertise of the professionals within it, it beggers belief that you would cut funding to centres that ensure all staff are properly qualified.
It is easy to say so many thousands will be given to this, and millions will be saved by cutting that, but to understand what it really means needs a higher level of engagement than just accepting the political spin.
Sadly this Government is known to base its policy more on television polls more than research and professional advice.
Like or Dislike:
3 
1 (+2)
sprout – with the $12m fruit for schools programme, there was only $6m left after admin to spend on fruit – that’s appalling.
We’re not delivering it to Ethiopia, and even if we were we should be able to do that for less than 50% of the funding.
Sport – you claim the money “mainly” goes to elite sports people. Do you have any factual basis to claim that most goes to elite sports?
How many elite sports people are there in primary schools anyway? (who get a large share of the funding)
As for sports coordinators – their scheme was combined with Kiwisport, so your info (from a Labour Party Press release) is a bit misleading.
You talk of flawed National Standards – yet they are working very well in our school. My kids are actively seeking out things that can improve their maths and reading outside of school.
This is because of suggestions in their reports of things that would help them achieve the National Standard by years end.
They’ve made improvements already, but for political reasons, some on the left think this is a bad thing.
Our kids are more important than someones wrong-headed political ideals.
Like or Dislike:
2 
3 (-1)
Photonz1-I think the real proof of National’s policies and initiatives will be when our appalling statistics around the health and welfare of our children undergo dramatic improvement and those struggling in education also show positive change. At the moment I am just hearing stories of schools and families struggling to meet the needs of their children and much of the changes having a negative impact. But I accept I am biased in that I generally focus on human outcomes rather than fiscal, and supporting those in greatest need rather than the elitist approach of this government (the $35 million of extra funds given to private schools was just another example).
Much of what I have stated still remains valid becuase it is largely around process and intent. Too much bureaucracy can indeed be a problem, but to totally wipe or gut a bureauracy without proof of inefficiencies is unwise. Much that this Government has done in its 1st term has been pushed through by the use of dubious “urgency” and ignoring advice or using proper checks and balances. There are also lots of examples of wiping one scheme then making much of delivering another that will probably deliver less than what it replaced. Ask the elderly, families with young children, caregivers, teacher aids and classroom teachers if they feel supported by National’s initiatives and I think you get the real stories. I think we will have to agree to disagree.
Like or Dislike:
3 
2 (+1)
sprout –
There are sensible iniiatives from the govt, like making it a legal requirement to report if you know a child in your house is being sexually or violently abused.
And then we get the Green Party saying in the media they don’t think it should be a crime to keep quiet about children being abused.
Who are they trying to protect? The children being beaten or the parents?
Like or Dislike:
2 
2 (0)
Photonz1-difficult issue, many things should be a requirement or be morally expected but to make things a criminal offence is removing possible descrection in situations that may not be black and white. I’m afraid I’m not up with the play on this issue, however, perhaps Toad or Frog can provide the background?
Like or Dislike:
1 
3 (-2)
Getting back to the issue of diseases associated with poverty, the question I’d like to ask is how do we effectively deal with these?
Its more complicated than simply putting money into health care. Whilst the original posting is about rheumatic fever, this is just the extreme tip of the iceberg. There are a lot more common diseases associated with poor (often crowded) living conditions, such as skin infections. The problem with many of these common infections in the community is that they’re developing resistance to antibiotics, and in the future will become a much more serious problem than they are today.
The government could put money into making doctors visits and prescriptions free. But unfortunately this will only partially solve the problem. As I think photonz1 is alluding to, there are parents who will not treat their children properly, even if the government puts a lot of effort and money into making the proper treatments available. I’ve seen families with sick children, who have the correct medicines in the house, but the medicines are not being used properly. Not only do the kids stay sick for longer, but only giving someone their medicine every now and then is a good recipe for developing resistant strains of the diseases. Its partly an educational thing; sometimes the parents are unaware that they are doing something wrong. However, sometimes its ignorance coupled with not caring. How the hell are issues such as this dealt with?
Like or Dislike:
2 
0 (+2)
Thanks Samiuela. Here are some of the things I think are necessary:
1. Deal to the underlying causes of marginalisation (“risk environments”). We know that most disease is associated with poverty, poor housing, unemployment, discrimination, under-education etc. The Green Party’s Mind The Gap package was intended to demonstrate that these are not just immovable facts of life, but rather phenomena that we can do something to change if we have the political will to do so. In fact, adopting measures like these will produce very large benefits not only in health status, but in more or less every other aspect of life also.
2. These underlying causes (and the diseases, and poor results in other indicators, that they cause) are clustered in particular communities. A focus of public health investment should be in devekoping genuine partnerships with such communities. They know what will work best for themselves, so the role of state agencies is to provide information about health status, prevention, what has worked elsewhere and what hasn’t etc and the dollars needed to implement the communities’ own solutions. This is all the more powerful if this is also the approach of education, social welfare and other social services agencies, and these resourcing efforts are coordinated and not siloed.
3. In tandem with this ‘whole community’ work we also need people whose job it is to make contact with individuals and families who may be at risk, with the licence to help them work out what help they need, and the authority to be able to direct the efforts of various agencies to provide this. We have something similar with Strengthening Families. That’s great, but it only kicks in once something has gone catastrophically wrong, and I want something more proactive than that.
4. Free or very low cost access to primary care. Also with other barriers lowered, so physically located and open at times that make the services as accessible as possible, and provided in a way that does not create cultural barriers.
So there’s four steps. There’s more of course, but let’s start there. These would have an enormous impact on NZ health (and education, crime, social welfare, abuse etc etc) status, and while they involve substantial reorganisation, they needn’t actually cost any more than they do today. More money directed here (in lieu of some of the savings from less wreckage later on) would help, but I could design a version that would work for no extra money at all.
Just political will then. As usual.
Like or Dislike:
2 
0 (+2)
We have a community-owned health trust that runs a hospital as well as a clinic in each community with district nurses who can do a great deal of the on-the-ground primary health care. Part of the health trust’s mandate is health promotion: food, exercise etc; prevention of illness with free health checks for everyone on the books (the whole community) and free basic dentistry for all, but with a focus on young adults.
Because there is no charge for doctor’s visits or prescriptions and schoolchildren are regularly checked for such things as glue ear, short-sightedness and nits; there are regular baby checkups; respite care for those with elderly or disabled family and many other initiatives for community health, the influence on the whole community is very positive. The trust board is composed of elected people from each community and the annual reporting meetings around these areas are always well-attended. It is our health trust and our hospital and we value it. It is also cheaper to run on a per capita basis than most other health organisations. And it is bi-cultural.
Like or Dislike:
2 
0 (+2)
Kia ora Janine! I love Hauora Hokianga. It is absolutely on the right track.
Like or Dislike:
0 
0 (0)
Kevin – there are already the pre school checks which happen BEFORE something goes catatstrophically wrong.
And although the programme hasn’t been going that long there are some very positive results starting to come from it.
But talking to those who work on the front line of it, there is a lot of cynicism about extra resources being given to the families they see (i.e those who don’t bother taking their kids to the doctor when they are sick).
If their childrens health, cleanliness, safety and nutrition are already a lower priority than their own entertainment, booze, drugs etc, then you know where any extra money will go.
They usually feel like they are banging their heads against a brick wall – and little short of full intervention will do anything.
We’re now intervening with health – that can be increased. Food in schools might help with nutrition.
And Gareths standards for rentals is a very good way of improving housing standards.
Like or Dislike:
2 
0 (+2)
Yes, I think b4 school checks are pretty good (though could be better). I acknowledge that there will be families encountered where exactly those distorted priorities will be the case, tragically. I don’t envisage trying to meet the needs of such families by giving them money. Rather in those cases what I have in mind is a coordinated and proactive attempt by helping agencies to meeting that family’s needs, including reversing those priorities. If the priorities are as you describe, then a prime motivation has to be the health and safety of the kids, so I believe a proactive and close involvement from CYF is likely to be important.
Where I do think actual money being made available is in resourcing community initiatives. It’s been demonstrated time and again that programmes developed and implemented by an affected community are much more likely to be successful than those implemented from outside. So a classic intervention might be identifying community leadership individuals and groups, and providing them with information about health issues affecting their community, then being on hand to resource with expertise and knowledge the community figuring out how best to tackle those issues, including funding the programmes. An example is the ‘Ngati and Healthy’ eating and activity programme being implemented by Ngati Porou in Tai Rawhiti. It’s hugely successful, but only because that community feels it owns the programme. I worked myself in the NZ AIDS Foundation for 10 years. The same principle lies behind that: we knew and persuaded the Government that for HIV prevention programmes to work for men who had sex with other men, they had to be designed and implemented by people who knew the subtleties of the different sub-cultures, and who would be trusted by the target group.
I know that some people and families are so damaged that it can be very difficult to change things for them. Seems to me though that we should be trying to do everything we can.
Like or Dislike:
0 
0 (0)
Kevin – The current govt has had a big push to increase B4 school checks, from memory from reaching 11% last year to 60% this year and currently pushing for 80%.
Good story on National Radio at 9.09am last Monday on B4 school checks
http://www.radionz.co.nz/national/programmes/ninetonoon/20100726
One worrying statistic is the poorest 20% of families are having half the babies born in Hawkes Bay. In other words the people who can least afford to have children are having the most.
Like or Dislike:
0 
0 (0)
Kevin has some good ideas for solving health problems associated with poverty, and Photonz also highlights some of the things which make it not a straight forward task.
Obviously tackling the causes of poverty is one of the underlying things which needs to be dealt with. However, if one had to identify a single thing that would have a very positive effect, I would personally say that having fully government funded GP/health clinic visits and prescriptions (perhaps with restrictions on expensive medicines) would be a good start. Its not going to solve all the problems by a long way, but at least it takes money (or lack of money) out of the equation when seeing a doctor.
Like or Dislike:
0 
0 (0)
samiuela – I haven’t agreed with a lot of what Winston Peters has said or done, but his free doctors visits for under 6s is excellent.
I’m not sure of the huge cost of totslly free visits, but I wonder what it would cost to extend this to under 10s, or 12s, or all school children.
Although as my wife and her colleagues say (who do B4 school health checks), all the free services in the world are useless if deadbeat parents have a very low priority on their childrens health and don’t bother taking them to the doctor, free or not.
Like or Dislike:
0 
0 (0)
Photonz1,
I was thinking of free visits and prescriptions (with restrictions on expensive medicines) for everyone. The cost would be high, but then savings would be made from diverting non-urgent cases from hospital emergency departments. Also, as they say, “a stitch in time saves nine”.
The extra cost could be funded by a levy on income tax which was specifically marked for funding the scheme (ie it wouldn’t be diverted away into other things it wasn’t intended for). The secret is to design the scheme so that it is difficult for doctors to rort it by providing unnecessary or overly expensive treatments … I’m not sure how this would be best done.
Of course this won’t solve the problem of deadbeat parents … but I honestly don’t know what will solve that problem which is not also inhumane on the kids.
Like or Dislike:
0 
0 (0)
samiuela – it would be interesting to have it costed, and to find out if GPs could cope.
There’s some here who think they won’t cope with a small number of sick notes for those people suspected of faking a sickie.
I suppose the rorting might be stopped by having a govt based system, but would that end up with a bloated bureaucracy and be less efficient?
Like or Dislike:
0 
0 (0)
It’s tricky. For the most part general practice is still a private business and since the 1930s, when Savage first tried to make doctors’ visits free, the profession has resisted attempts by the State to control things more. By and large during the last Labour government the deal was that the Government put more into the money it gave general practice (a lot more in fact – when Tony Ryall complains about all the extra money Labour put into Health without any increase in elective surgery, that’s because it went into primary care) in return for lower caps on the fees doctors could charge patients. The cost of that exercise was massive. To extend the policy to make primare care completely free would be very high, and would probably still be resisted by the profession as they would fear becoming controlled by the State.
Additionally there is the issue of capacity. There is (except in wealthy areas) generally a short supply of GPs. Probably we need a multi-year plan to ease down the cost barriers to primary care at the same time that more doctors are steered into primary care.
Like or Dislike:
0 
0 (0)
Fair enough points Kevin. However a couple of things come to mind:
1) Making GP visits “free” won’t actually cost the country as a whole nearly as much as one might think. Instead of individuals paying out of their own pocket, the funds would have to be raised through extra taxation. The money is currently being spent on GP visits, its just not as obvious as if there was a taxation funded system paying the costs. Essentially it would be a government run insurance service which spreads the costs of healthcare more equitably.
Extra costs would come through (a) administration of the service and (b) extra GP visits which would not have been taken if the individual was paying directly.
Obviously a well designed scheme will aim to minimise the administration and bureaucracy costs. If a free scheme encouraged more people to see the GP is this a bad thing? Obviously we don’t want GPs being flooded with people suffering colds. However, is it the case that some people are not currently visiting the GP when they should because of cost? (thats a rhetorical question).
Interestingly, the number of GP visits per person per year varies greatly for different countries. Here are some statistics:
http://www.nationmaster.com/graph/hea_con_wit_doc-health-consultation-with-doctors
The UK only has slightly higher GP visits per year per person than New Zealand (4.9 compared to 4.4), despite most primary health care costs and prescriptions being covered by the NHS.
So the point I’m trying to make is that the cost of a fully taxation funded primary health care system may be quite affordable. Essentially the 4.4 doctors visits per year plus whatever the average prescription costs per year per person are would need to be covered by increased taxation. The average person with average health would probably not notice much difference in their budget (more tax but no GP and medicine charges).
2) If there is a capacity problem, and there are not enough GPs for a fully government funded service, then what is happening now? Are people simply not seeing the doctor because they can’t get an appointment and either get better or end up in hospital? Is it acceptable to maintain the status quo because this hides the shortage more effectively than if it was out in the open?
3) Your point about opposition from doctors is probably more of a sticking point than anything else. Maybe by offering free training in return for being required to work in the public health care system (doing whatever) for a specified period is the way to make inroads on this problem?
Like or Dislike:
1 
0 (+1)
Thanks Samiuela. Good argument about cost – and of course we would support increasing the taxation revenue (from a broader base) and using this to fund the health and education services that we need.
And please don’t think I think the status quo with GP numbers is adequate! Just having been in the position of trying to drive increased availability of primary care and really hardly succeeding at all (in fact continually struggling with a number of well-paid but vacant GP positions). There are quite a few barriers to actually making this shift. We need to train, attract and retain more GPs and we also need to recognise the terrific role that nurses can play in primary care. Much of what GPs currently do could also be done by well-trained nurses (or nurse practitioners). So let’s change those professional boundaries that see this potential continually being overlooked or stymied.
I’m a big supporter of the idea that tertiary education should primarily be seen as a public good. We all benefit from the training of doctors, engineers, physiotherapists etc etc, so we should pay for this, just like we used to. Instead the National Government in 1992 introduced student loans and both Labour and National governments subsequently have supported this policy that has, as its foundation, the idea that tertiary education is a commodity that confers principally (or only) a private benefit on the person being educated. And in the meantime we have developed shortages in most workforces that require tertiary training. In fact we generally train enough, but they head overseas because they need to earn higher wages than they can in NZ, in order to try to get their student loans repaid. In other words that ideological belief about tertiary education is totally disconnected to the reality of every other part of our society and economy.
So let’s scrap student loand, pay students a decent living allowance while they are studying and bond them to work in NZ, particularly in our hardes to fill positions. That’s a broader argument than just medical training, but the medical workforce illustrates the point perfectly.
Like or Dislike:
1 
0 (+1)
Kevin – if you had free tertiary eduction, how would you chanel students into courses that were actually useful to the country?
There is a big enough problem now, not only with courses of little practical value, but even things like law dregrees where around 60% of graduates do not find work as lawyers.
Even with students paying just a third of actual course costs, this is still massively inefficient for everyone.
Taxpayers probably waste billions. Students waste thousands, as well as four years of their life.
My idea is for the government part of course costs to be scaled towards what percentage of graduates get work.
If we need radiologists, then they would all get work when they graduate, so they would get full funding.
If only 40% of law grads get work, then they would get a relative part of their course costs paid.
People can still do a degree in rabbit psychology if they want, but if there’s little chance of a job in that area then they can’t expect as much subsidy from the taxpayer.
Free tertiary education is well and good, but you’ve got to pay for it somehow. With current student numbers (paying just a third of their costs) that will triple tertiary expenditure. We have a lot more people enrolled than we did in the 70s and 80s, and if it was free, then we’d have even more.
You will have to suck massive amounts of tax out of workers, and there’s no guarantee that graduates still won’t go overseas for better money, like they always have (and to excape excessive tax?).
The beauty of a scaled tertiary subsidy scheme is
1/ anybody can still do any subject
2/ it chanels people towards the skills the country needs
3/ less unemployment
4/ more efficient
5/ not wasting four years on a useless degree
6/ it could be used by a left or right wing govt (i.e. govts might increase or decrease funding, but it could still be done with scaling).
7/ gives students a much better idea of their work chances BEFORE they choose their degree – not the rediculous current situation where many don’t know there’ not much chance of a job until they’ve wasted four years and ten of thousands of dollars.
Like or Dislike:
0 
0 (0)
A general education is a complete waste of time and the skills gained from it are not transferable. Quack.
Like or Dislike:
1 
0 (+1)
Part of the rational for student loans was 1. It enabled more people to go to University. 2. Why should those who do not pay the full costs for those who do, Having to pay part of the costs for your courses is fair.
Universities need to update their standards of teaching also. We had fun critiquing lecturers. Some were excellent, but many lectures were a waste of our time and the lecturers. The captive customers allows them to get away with to much. Having to pay for part of the costs make students more aware of the real value of education and less tolerant of poor providers.
The problems with repayment can be solved in the same way private debt or fines are enforced. Credit rating, no exit until paid etc.
Having said that, the purpose of education should be much broader than simply providing cheap job fodder.
Governments get away with a lot of the crap they do because most people lack a general education and understanding.
Critical thinking, research skills and innovation are important parts of education which teaching to narrow standards does not address.
When the CTU suggested a civics course on finance, rights and responsibilities at work and budgeting, big business opposed it because people could not be ripped off so easily.
Economics at high school is very basic and uncritical.
On the medical costs. Doctors are one of the strongest trade Unions. They along with lawyers get away with things that would get the attention of the commerce commission if others did it. Note the Phsio’s recently.
Like or Dislike:
0 
0 (0)
Love y’work solkta!
Keep quacking that whip!
Like or Dislike:
1 
0 (+1)
The reason why our tertiary trained people head overseas is that Government policy and immigration are designed to keep wages down especially for skilled people. Only professions such as Doctors and Lawyers have had strong enough associations/Unions to restrict entry and set fees at a higher level. The Doctors are slowly losing, but Lawyers are still on a gravy train.
Like or Dislike:
0 
0 (0)
“”And socialism is the solution is it? Hasn’t worked anywhere else in creating wealth amoungst the poor….”
Yes it has actually. Finland, Denmark, Norway etc.
Neo-liberal extremist countries like NZ the US and UK have the highest income gaps and the lowest wages in comparison to prices. Small business in NZ, US and UK are not doing so well either because wage earners and beneficiaries spend their money locally.
Like or Dislike:
2 
0 (+2)
When the CTU suggested a civics course on finance, rights and responsibilities at work and budgeting, big business opposed it because people could not be ripped off so easily.
Is that the real reason or your made up reason?
Like or Dislike:
0 
0 (0)
Kerry says “The reason why our tertiary trained people head overseas is that Government policy and immigration are designed to keep wages down especially for skilled people.”
Rubbish. Kiwis have always gone overseas. A huge number of people HAVE good jobs here, and leave them to go on their OE with no guarantee of any job. Virtually everybody I knew when I lived in London left good jobs in NZ – that’s how they got their travel money together.
The main reason our tertiary trained people go overseas is to see the big wide world. And many of them get opportunities in the big wide world that don’t exists here, and never will, no matter what the govt policy is.
Like or Dislike:
0 
0 (0)
In my last job I was most concerned with what took medical graduates overseas. Certainly the usual OE reasons still apply, but for many others there seemed to be sense of necessity: they had a huge debt from their student loan and saw the higher salaries available overseas as their best option for repaying that as fast as they could. In other words, despite our deep and growing problem with a doctor shortage (and we have the same problem in other health professions) we have a policy environment in which the most rational choice for our medical graduates is to leave.
I agree that there is a difference between those courses of study that are effectively training for an occupation/profession for which there is a short supply, and those that train for an occupation in which there is no shortage, and those aimed at an education, rather than training. That said, however, my sense is that these other categories of graduates also bring benefits to society, albeit not as direct. I have studied Scandinavian Studies to Stage 3 level, for example, and can think of multiple ways in which the value of the other things I do is enhanced by my learning in that area. Not universally true, perhaps, but my impression is that it generally is.
Like or Dislike:
0 
0 (0)
…we have a policy environment in which the most rational choice for our medical graduates is to leave.
Wouldn’t this still be the case, student loan or no student loan?
Like or Dislike:
0 
0 (0)
Kevin, so it would be a benefit, and less doctors would probably leave (and more train), if more taxpayer funded subsidy was spent on medical studies (and less on unessassary study).
I hear the “greater benefit to socciety”, and “teaching critical thinking” arguements all the time, for why the taxpayer should pay for irrelevant courses. It doesn’t ring true to me.
But I’ve never seen anybody making that arguement come up with any proof or studies that show doing an irrelevant course is of GREATER benefit than doing something else (like a relevant course, on the job training etc).
And they’ve certainly never made a case that it is SO much better than the alternative that it’s worth spending tens of thouisands of taxpayer dollars on it.
Like or Dislike:
0 
0 (0)
@Stephen – Yes, so long as the mix of salary/quality of life is better in other countries. However, a significant proportion of the medical graduates who leave would prefer to remain here, and the factor that tips the balance is the need to repay the debt as quickly as possible.
@photonz – You’re right, I don’t have evidence (at least not here at home), just impressions. But really what I am arguing is that my impression is that there is such a benefit (BCR>1), not that it’s the BEST investment. If we are to compare those possible state investments with positive BCRs (let’s just overlook the shortcomings of that kind of analysis for the moment) then we ought to look across the whole spectrum, rather than just in education. $30billion spent on new roads (over 10 years) with an average BCR of slightly more than 1 (and that assumes a stable oil price) would free up an awful lot of resource to fund other investments, were this programme not to proceed.
Very interesting discussion. Thank you. Probably I should go and do “day off” things now! Back later on though.
Like or Dislike:
0 
0 (0)
It’s a culture problem photonz, certain attitudes in our changing society have unfortunately dismantled many things that were actually “good” because they are now considered “bad”.
There are failed and failing experiments in just about every aspect of our society, desiring change is not wrong, but lacking the patience to do it properly most certainly is.
Like or Dislike:
0 
0 (0)
High school students should only be offered vocational courses as there are no studies that prove that irrelevant courses are worth spending tax payers money on. Quack.
Like or Dislike:
0 
0 (0)
Thanks Kevin, yes that occurred to me as well, but it’s awfully difficult to quantify any of those factors, which makes it a bit weak (for now) IMHO.
Everyone back to work before you get the whip!
Like or Dislike:
0 
0 (0)
kevin – I think there’s no doubt that there’s some benefit in doing courses even if they are irrelevant.
However if those courses cost taxcpayers $60,000 (or whatever 2/3 of the average course costs are), then the overall effect is probably negative.
Effectively it comes down to this. What has the most benefit to the country for spending $60,000 per student of taxpayers money?
Doing a relevant degree that the country needs?
Or doing an irrelevant degree with no job prospects?
Like or Dislike:
0 
0 (0)
Stephen.
Yes that was the real reason. Education that simply said that trade unions exist and what they do as well as telling people what their rights were and the problems involved with obtaining credit was considered political and strongly opposed by business groups. So now you can do “enterprise studies” which assume everyone is going to be an entrepreneur, but not studies on what happens if you lose your credit rating.
I have to say though that to their credit one bank has proposed financial literacy as a core subject.
I have seen many teenagers who are going to have problems for life because of a bad credit rating after banks and finance companies happily loaned them loads of money without bothering to tell them the likely consequences of default.
Like or Dislike:
0 
0 (0)
Thanks Kerry. Not sure how you could do an entire course on what you’re talking about there – there is an awful lot more stuff that’s taught at school these days compared to what used to be the case. Surely possible to do a one-off or something while treading very carefully around the politics of it all.
Not a lot of sympathy for folks who borrow loads of money when they can’t pay it off either, but that’s another story.
Like or Dislike:
0 
0 (0)