Heather Roy's Diary – 21 April 2006
Heather Roy's Diary – 21 April 2006
The fallout from the decision by the Hawke's Bay District Health Board to cut 1800 patients from their waiting list by sending them back to their General Practitioners is continuing to be felt.
The Minister of Health, Pete Hodgson, did not welcome the bad publicity. He searched his soul and, having found nothing wanting, blamed everyone else. He issued a press release that contained the following paragraph:
"Indeed, the situation leading to yesterday's decision may have contravened Medical Council guidelines. The Council has been clear that health services have a duty to only accept referrals that they can handle within available resources."
The Medical Council makes the rules about what is and isn't ethical for a doctor so the Minister seems to be suggesting that the doctors involved should be punished. That is not uncharacteristic of this government but it is necessary to stop and consider what exactly happened at the Hawkes Bay District Health Board.
It should be remembered that the 1800 patients who were discharged were those waiting for a first specialist assessment. They had been referred by their GPs for a specialist opinion and had been put on a waiting list. By this stage the patients had not seen any hospital doctor so talk of unethical behaviour is simply ridiculous. His statement was described by Ian Powell of the ASMS (the senior doctors' union) as unfair, unwise and untrue.
Invercargill general surgeon, Murray Pfeiffer, pointed out that it is a common misconception that all surgeons do is operate. He said
"GPs refer patients for specialist opinion in good faith because they believe it will benefit them and claims that they could better manage the system are fundamentally insulting to their intelligence."
He also made an important point about managing waiting lists:
"The DHB can't be expected to know what resources it requires for surgery until patients have been assessed. The Minister is expecting the Board to be clairvoyant."
So what can be done?
Most people agree with these criticisms of current health policy but don't believe anyone has the answers.
In fact there is no shortage of ideas for improving efficiency. For example, Hutt Valley District Health Board member, Peter McCardle, is advocating a subsidy for people who opt out of public hospital waiting list to go privately.
A number of readers have drawn my attention to a measure in Massachusetts that would make health insurance compulsory and subsidised. A novel aspect of the plan is the creation of a health insurance "exchange", to relieve small firms of the need to conduct complex negotiations with insurers. The employees will be able to choose any plan approved by the state-backed exchange, just as any customer can choose a plan now.
It is hoped that with more healthy people in the pool, average premiums should fall, or at least rise less quickly. The burden on accident and emergency should be reduced, because insured people are more likely to go to a doctor before a problem becomes critical. You can read more about this option at http://www.economist.com/world/na/ displaystory.cfm?story_id=6772453
It isn't a lack of ideas that stifles debate on health but a government belief that there is no rationing in the current system. Simply put there is rationing, as there must be when demand exceeds supply. Government continues to pretend there is no rationing until the system bursts and 1800 patients are unceremoniously dumped.
Core Services Debate
In the early 1990's, under the National Government a committee was set up to look at what should and shouldn't be available or provided to patients in the public health system.
Although the intent was commendable the committee floundered for many reasons and no decisions were reached. One reason is that health decisions are not black and white. Frequently there are social factors, which compound problems for patients. Bureaucrats should not be making clinical decisions of this kind anyway - our doctors and health professionals are exceptionally well trained and the only ones able to properly prioritise those in need of care.
Minister Hodgson in recent days has also been very critical of this debate, which he described as an outright failure. What he didn't say is that the debate itself was important and at least that process happened in public. Labour arrogantly assumes that it knows best and has had its own de facto Core Services Debate behind closed doors.
Politicians have made the clinical decisions about prioritisation of health spending leaving the doctors disenfranchised. Helen Clark's announcements about extra funding for hip and knee replacements and cataract surgery is exactly the same - but her motive for doing this is clearly about shoring up support at election time rather than her thinking that these operations are more important.
At the very least Labour should be considering patients first and encouraging District Health Boards to use precious health dollars on the best quality treatment in the best time at the best cost. There is an artificial barrier between the public and private health sectors.
People don't mind where they have their treatment as long as it is of a high standard and received promptly. So while Labour keeps its ideological blinkers firmly in place beds and theatre space will go begging at private hospitals around the country - beds that could be used to treat those suffering now and save the taxpayer health money in the future. Is this really too much to expect?
Private Roy reporting for duty
I have joined the Army's Territorial Force and to comply with training will spend the next six weeks attending Basic Training in Waiouru. In my absence the Diary will have Guest Columnists - I hope you will enjoy their articles. Most questions you have about my military career are answered in an article that was published in this week's 'Army News', which can be viewed at www.act.org.nz/army.