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September 29, 2008 | by  | in News |
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The State of Health, Are we in a healthy state?

Political Editor Jackson Wood wants to hold you in his arms ‘til you can feel his disease. That disease being an affliction of politics.

Health is something that I am fond of. Currently as I dictate this to the Salient dictation monkey I am in bed with a case of pneumonia. I like health. I wish I had more of it.

If we’re in good health we can work, we can play and we can live to be productive members of society. If we’re in bad health we become unproductive, cannot contribute to society and in some cases become a drain on society.

Health spending by governments has for the past twenty years consistently ranked in the top 3 issues which people care most about. In the last financial year the government spent $9,932 million on health, with an expected $11,343 million during the next year. We consistently spend between 6.5% and 8% of New Zealand’s GDP on health. This is compared to 1.6% of GDP on law and order, 1.44% on defence and around 6.8% on education. So we throw a lot of money at health. But we constantly hear of massive waiting lists, no beds, few doctors, junior doctors going on strike. So we need to look at the policies which the parties have to offer to see if they will make the money we invest in the health system work for us.

As a person who is currently sick and a voter in the upcoming election I think the health policy is something we should all be looking at intently. There have been three major changes in the health system over the past twenty years. Changes which Peter Davis, professor of Social Policy at the University of Auckland, has called unnecessary and in some cases detrimental to efficient day to day operations of the health system in New Zealand. So a wholesale ‘burn it down, start again’ approach is probably not the best option for health policy.

ACT rightly points out that Labour does not want health to be an election issue this time around because of the amount of money that they have thrown at it for few substantial gains. As per their liberal ideals ACT intends to “encourage individuals to take personal responsibility for their own health.” ACT’s health spokesperson Heather Roy promises a “comprehensive reform of the Ministry of Health”. Their policy has three major goals:

Cut waiting lists by removing “waste” from the system and allowing the extra money to be spent by DHBs to contract out to private hospitals and practices.

Provide tax breaks for people who use private medical options and private health insurance.

Remove bureaucratic jobs from hospitals and cut the number of members on DHBs.

In the same fashion as ACT, National want to reduce waiting lists by allowing DHBs to use private medical facilities in public-private partnerships. They want to increase choice and ensure that rural areas have adequate services so that you can get primary health treatment at a hospital or clinic near you.

One of the prospects of National’s policy is the promise to open up ACC to competition for workplace insurance. Price Waterhouse Coopers has recognised that the way in which accident compensation is run here is more efficient, and has delivered significantly better results for all citizens, than comparable open competition based insurance schemes. National, however, want to introduce competition and choice into the market. They have said that in their first term they will not sell ACC, but the opening up of the compensation market makes it easier to then say that some of us are paying twice (once through taxes, once by choice) for insurance, so let us be rid of the one that for 35 years has worked the best. Health policy should be about delivering the best care for the lowest price. ACC is about 250% cheaper than what Australian business pay on an open market.

National claim that because there are no penalties for continued workplace safety violations, ACC does not sufficiently promote work place safety – the idea being that if we have companies insuring businesses, the increased premiums if accidents continue to happen will force workplaces to become safer. ACC claims that prevention is an increasingly large part of their mandate.

The brain drain of medical professionals to overseas jobs with higher salaries is also something that National is keen to combat. National’s health spokesperson Tony Ryall has announced (well kind of. Thanks Trevor) a bonding scheme where medical graduates who stay here in New Zealand will have up to $10,000 of their student loan written off. Which would be a fantastic way to help out med students whose student loans can run into the hundreds of thousands.

The overall picture National have is of a place where the individual is the one who has the choice and health services should be known about and promoted. The services should be provided by both the government and the private sector and, because of this, New Zealanders will benefit. National’s policy seems to have benefited from a discussion paper they put out earlier in the year (although the many pictures of John Key were slightly off-putting).

The curious beast that is Labour has for the past nine years of its reign concentrated on a few little things to make the overall health of the citizenry better. Smoking and sexual health are prime examples. I now can’t buy a packet of ciggies without images of zombie movies staring back at me and I can’t visit a prostitute without them insisting that I wear a condom.

Although Labour launched one of the reforms of the health system in 2001 they’re optimistic that they have done the right thing and that continued modification of the model they now have in place is the answer.

They do not have a pre-election health policy out as of the time of writing, and my attempts to get in touch with Mr Cunliffe were not successful. In a speech to the NZ Institute of Health Management, Mr Cunliffe noted that there are three key areas of improvement. Moving primary and preventative healthcare to the next level, making sure we can trust health services, and taking a strategic approach to providing a trained workforce with good facilities.

Labour stresses the need for a healthy workforce, and a healthy health workforce. They, like the Greens, would like to see more of a prevention and promotion element to the health system.

The Greens health policy (and here I must declare a potential conflict of interest as earlier in the year I worked for Sue Kedgley through the Parliamentary Internship paper that is offered through the Political Science department at Victoria, and I contributed a few lines to the policy about electromagnetic radiation) is pretty long and comprehensive. Their policy boils down to a holistic approach with adequate funding so that everyone can be healthy regardless of income.

The Greens want to see a preventative health system rather than a sick system, where healthcare is affordable so people will solve health problems before they become major issues.

It goes into specific policies on the combatting of cancer, maternal health, and electromagnetic radiation. One of the problems behind the Greens’ policy is that it is written primarily by volunteers and party members, some of whom are bat shit crazy and think that immunisation is bad and that homeopathic cures are of greater value than proper medical treatment. Although the polices are set out well and are easy to read and generally sensible, some people think that they are out of touch with the majority of New Zealanders’ expectations of our health system.

I have a problem with the invasive nature that the Green party takes on providing health policy. We can’t be forced into choosing healthy lifestyles, which is how the Green policies come across at some points. This paternal instinct is countered by their policy to control the National Health Index by passing legislation to ensure privacy. All of the parties end up with the same ideas in their policies: the slashing of waiting lists, better health for citizens, better availability of services. The ways in which they differ are what we need to look at.

The health system should be about the lowest cost to the individual and to the taxpayer for the most efficient service. On that basis no one party has an answer. ACT because they don’t think the government should be providing health services; National because they think the government should continue running existing services with private interests filling the gaps; The Greens because they rely too much on the public facilities and their responsiveness to change and ability to provide a one stop shop for all health needs; Labour because their devotion to a publicly resourced and controlled health system delivers reasonable outcomes for most, while failing others.

We should be looking at holistic approaches in health policy and we should realise that healthcare is not entirely the responsibility of the Government, but that people make choices which no government can control without taking over our lives. Neither can the private sector, with a focus on profit, undermining its (public) competitors.

Our health system has been through much cathartic change over the past twenty years and another massive change would probably be the worst thing for a system which is already strained.

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The editor of this fine rag for 2009.

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