The Labour Party came to power partly on a campaign against what National had done to the public health system in New Zealand. Labour promised to fix it. But little has been done that ultimately fixes the problems from the patient's point of view. Recently the NZ Herald has been running a series of articles on the state of the heath sector - unsurprisingly it has been rather critical. It has concentrated on the dilemma of growing waiting lists, the unavailability of basic operations, the increased involvement of the private sector, and the wildly variable prospects of treatment in different areas. [Read much more below]
According to the Herald, it is now extremely hard to get operations through the public health system. Unless you are in need of urgent surgery, you are likely to remain waiting for some time. Some non-emergency surgery will never be done - the 'long-term trend in elective treatment is causing surgery such as hernia repair and varicose vein removal to become almost unobtainable'. Apparently, 'The number of patients receiving elective surgery was little higher in 2005 than in 2000'.
Even if you are eventually going to get surgery, it will take a long time. In terms of heart-bypass surgery, one senior health source told the paper, 'Someone who should get an operation within several weeks is waiting several months'. Another GP says that 'Patients with suspected skin cancer are being squeezed out of the public health system' because it takes so long for suspected cancerous skin to be seen by a specialist. Furthermore, the paper found that 'radiotherapy waiting times for Auckland cancer patients are now three times the recommended guidelines' - as 'priority C' cancer patients were waiting for around 12 weeks for treatment, when the Ministry of Health guidelines stipulate four weeks is the 'maximum acceptable'.
Waiting lists are therefore at the core of dissatisfaction with the health system. Thus, Labour and National have decided that 'waiting lists cannot grow to politically embarrassing proportions' and have had to be bluntly cut by sweeping the problem under the carpet. A new list system was invented whereby health boards were told to kick any patients off the list if they were going to have to wait for than six months. Thus the problem of lengthening waiting lists was cynically solved. The Herald calls the solution 'anything but honest'. And health boards that do not implement this system are financially penalised by the Health Ministry. And this has been done by the same Labour Party that opposed the booking system introduced by National 10 years ago.
The Herald says that the 'Public hospital waiting lists are a boon to the private sector' who have been able to 'cherry pick' the more straightforward cases, leaving 'public hospitals to do the difficult, expensive work'. This has led to a situation whereby more elective surgery is actually carried out in the private sector than in the public: 'Southern Cross funded 126,000 operations in the past financial year, compared with 105,000 elective operations in public hospitals'. According to Southern Cross, a growing proportion of patients are paying for private surgery - paying the full price, 'typically surgery costing less than $5000, such as hernia repair or cataract treatment'.
Unsurprisingly, the private health sector has been 'Positioning itself to do more state-funded surgery'. According to the Herald, 'The private sector has made repeated overtures to the Government, first seeking rebates on insurance premiums, followed by appeals to do more public-funded surgery and finally suggestions of joint ventures at public hospitals.' And so, 'ACC buys up to 80 per cent of its elective surgery from private hospitals and the Counties Manukau health board buys around 11 per cent'. It's interesting to look at where the modern private sector health get their funding from:
* 65 per cent of their patients are funded by private insurance.
* 20 per cent are Accident Compensation Corporation-funded.
* 10 per cent pay their own way.
* 5 per cent are funded by district health boards.
Meanwhile, the Herald found that 'operating theatres are underused. The likes of surgeons and anaesthetists still lament the poor resource use and managerial eccentricities they see in the system.'