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Howard's End: Still No Real Plan For Health

New Zealanders are not stupid. After years of being told that cancer can be beaten with prompt diagnosis and treatment, they don't want to be told that having to wait a few more weeks should not have an effect on their long-term prognosis. Maree Howard writes.

What New Zealanders want from their health services is actually pretty simple. They want high-quality care when they need it.

If they have an unusual lump or a worrisome pain, or any other symptom that may signal a life threatening disease, they don't want to wait for an over-burdened specialist to work through his or her long backlog of referrals.

They want to be diagnosed right away. And if that diagnosis turns out to be what they feared they want treatment which started yesterday. That's not been happening.

Furthermore, when they undergo treatment they want it to be world-class treatment. New Zealanders now see people on television from all walks of life, incidentally, including the most humble and inarticulate, receiving the most sophisticated medical treatments and they naturally want the same for themselves.

And if New Zealand really is the best place in the world to live, why shouldn't they?

But, increasingly, they don't believe the current health system is going to give them prompt, high-quality care. Emergency rooms are overcrowded. There are longer waiting lists for surgery, and more and more New Zealanders either know someone who has had to wait anxious days or weeks for diagnosis and treatment or have had to wait for it themselves.

Will more money solve the system's problems? An economist is required by professional oath to believe that more money is always going to help. Whether the shortage is of specialists, x-ray machines, nurses or tongue depressors, extra money lets you buy more of them. If people are waiting too long for cancer treatment, it is hard to see how hiring more cancer therapists and buying more cancer drugs will hurt.

But will extra money go into new services?

I predict that as soon as the new money Government is placing into the health system becomes clearer, nurses and hospital workers will start pressuring for wage increases.

And who can blame them? In many cases their wages have been frozen for years.

But if the new money goes to paying more for the same level of service, it doesn't solve the problem. So you then need even more new money, and as your population ages, still more on top of that.

New Zealanders now have to make a collective decision. Their Government either has to raise taxes, cut other public expenditure or go deeper into debt. And that's a problem.

If taxes and debt can't go up and other spending can't go down, there is going to be a crunch. What New Zealanders are prepared to give up when the crunch finally hits - and it will - might mean the difference between a universal comprehensive health care system available to all, or a more private health care system, or a combination of the two.

When it comes to the New Zealand public health system there is at least one thing upon which we can all agree: It needs to be changed to get costs under control.

Most of us seem to agree that primary health care, the "storefront" of the system, is in need of urgent attention. Shared-care practices, with teams of providers working in an integrated fashion have been slow in coming.

Both central and local government do not seem to have a consolidated vision and plan for primary health care. At all levels serious work needs to be done in this area.

But as the Government again experiments with change and reform, it could do well to remember our health system evolved in parallel with New Zealand values, and is a product of them.

I could write a whole book on what might be done but surely, for all of us, the first reform is to stay healthy.

My prescription would be: Let's decide how much we are prepared to spend, and upon what, and get on with it.

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