SUSTAINABILITY : Our health system’s running

Is our health service delivering? The answer, according to the patient, is no.
Kiwis have major worries about our health system. And many of us support some smart thinking about better ways of funding it, according to nationwide ShapeNZ survey carried out for the New Zealand Business Council for Sustainable Development.
Almost half those asked think the health system has deteriorated over the past five years. Almost three quarters think queues for non-urgent surgery will grow over the next five years. Two thirds of respondents believe the service is inefficient and almost three quarters say the standard of service depends on where you live.
Waiting lists are also major concern, but most of us are happy with the quality of service once we get to it.
So, how to fix it? Should the Government just spend more? It’s very expensive option. One in every five dollars the Government spends already goes towards health.
New technology, an ageing population and growing wage bills mean our rate of spending per head of population has gone up 70 percent in the past 17 years.
If the spending trend continues, by 2050 the current $12 billion public health bill will have blown out to $21 billion year in today’s dollars.
To fund that the Government would have to raise taxes, cut spending in other social areas like education, welfare and police or borrow more money.
But there are alternatives. And as the ShapeNZ research shows, New Zealanders are keen to have them investigated.
Many believe that allowing private providers to play bigger role in the health service is good idea. Almost 64 percent say District Health Boards and the Government should buy health services from the private sector – in much the same way ACC does to get people back to work quicker.
And over half believe private hospitals should be able to compete with public hospitals for the extra money the Government puts in to fund operations and hospital procedures.
But New Zealanders don’t think private competition is the only answer. Interestingly, 68 percent think the Government should be looking to build health fund – similar to the so-called Cullen fund for superannuation – to help pay future health bills of an ageing population.
And the majority of those surveyed would still back this plan even it led to delays in personal tax cuts.
Likewise, investigating personal ‘whole of life’ health accounts, funded by the Government but which individuals could manage – wins significant support.
Other ideas thrown up by the survey included compulsory health insurance for younger workers, and extending ACC to cover catastrophic illnesses, like cancer, which often stop person from working.
Nearly seven out of 10 say it will be acceptable to be flown overseas for treatment at more effective regional treatment centre than is available in New Zealand, with family member or other person in support.
New Zealanders also think we should compete for medical staff in the global market by offering incentives, but in return require medical graduates to work year here for each year of training they have received.
Despite the looming funding crisis, 59 percent believe the Government does not have to restrict the number of services available in the public health service, but 58 percent agree the Government should define minimum core list of public health services available to all. However, when asked who should define the list of core services, they plump for voters by referendum (41 percent) and medical specialists (37 percent), rather than leaving the job to politicians and officials.
There is no single magic answer to our health funding ailment. But there is looming funding crunch which, like our superannuation bill, won’t go away. And New Zealanders are clearly looking for some innovative thinking from politicians and policymakers to efficiently address it.

Peter Neilson is chief executive of the New Zealand Business Council for Sustainable Development. www.nzbcsd.org.nz Detailed papers and polling on the health funding issue are at www.budgetsummit.org.nz

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