Policy pivots, funding follies and privatisation perils

Some of the everyday happenings in the health sector are so odd you won’t believe them the first time you read them

Looking back over the past few weeks, I hardly know where to start. But start I must, mindful that a monthly publication must stand the test of time, it must keep on giving all month long. This leaves me in a bind; with the health sector highly politically charged and news dropping daily, there’s every chance words consigned to the printed page will be historical records when you pick up your copy (FYI, this is where our terrific email newsletter, Daily Triage, comes in handy).

I console myself with the fact that some of the everyday happenings in the health sector are so odd, you won’t believe them the first time you read them. And, often, there will be just the slightest hint of déjà vu.

When the news broke of a year-to- date deficit for Te Whatu Ora of $934 million, a good chunk of the over-spend was blamed on too many nurses, nurses who had somehow managed to get themselves employed by an agency with no budget for nurses despite having initiated recruitment programmes.

I dived into an old box of clippings, and sure enough – déjà vu – back to the health reforms of the 1990s, when sector leader Graham Scott put reform failings at the feet of patients – there were just too many of them. Maybe that helps explain why earlier this year the sector saw a hospital on Auckland's North Shore with no patients and no staff – maybe the perfect reform scenario.

Which leads me to worst-case scenarios, that is, those found in a report obtained by The Post following an Official Information Act request.

Should Te Whatu Ora have got only half its expected cost-pressure funding in Budget 2024, the released report outlined some options for finding savings. Honestly, the suggestions were right out of the “we need an emergency flat meeting” manual. They included reducing the range and quality of hospital food for patients and staff, skimping on air conditioning, increasing thresholds for access to care, reducing postnatal stays in hospital and introducing copayments for emergency department services, among others.

It’s entirely possible the authors weren’t born in 1992 when then National health minister Simon Upton put cash registers in hospital foyers to collect a nominal fee from inpatients.

A few months later, the cash registers were gone – public outrage and the cost of collecting unpaid charges saw them off the premises.

While part-charges for day surgery and outpatient services did survive until July 1997, charges were never introduced for ED. Nevertheless, payment technology has advanced since the 1990s. If the Government were determined to charge for public hospital services, it would find a way; between NHI numbers and IRD numbers, I expect anything is possible.

One suggestion, that draws a collective eye roll from anyone who’s spent time in a delivery suite, is that of reducing postnatal stays. I can only anticipate that any reduction much short of the length of time spent by many new mothers nowadays, would necessitate a u-turn about three blocks short of the hospital, before the baby was delivered.

And while I’m talking u-turns, in this litany of oddities, I cannot overlook the “independent” evidence associate health minister Casey Costello finally released to support her promotion of heated tobacco products, described succinctly in an RNZ report as “five articles that are either about different products, outdated, or only offer weak support for her view”. Ouch.

Amid the chaos, we might take some small consolation from the fact that Googling “health system” and “shambles”, elicits results from around the globe. We are not alone.

This brings me to our cover story – the mapping of general practice ownership.

Some commentators talk of the “privatisation” of the health sector as akin to a nasty infection, ignoring the fact that most health services are provided by private providers – GPs, nurse practitioners, midwives, physiotherapists, optometrists, audiologist, podiatrists and the rest.

This talk of “privatisation” can mean, on the one hand, the growth of insurance and part charges, which make some health services available only to those who can afford to pay, and, on the other hand, increased ownership of health services by “corporates”, entities that carry the risk of a profit motive divorced from the clinical good.

Some will argue that health businesses that allow the profit motive to take precedence will not be in business for long, but a lot of damage can be done should they be driven in a direction counter to the best interests of patients, irrespective of the dedication of individual employees. That's not to say non-corporate individuals or clinician groups are immune to incentives that fail to place the patient at the centre – every ownership option has its flaws. But as our mapping shows, the ownership by small groups of clinicians continues to be the majority model for general practice. And change is not happening as fast as some folk might have us believe. There is time to shape the future landscape of general practice, assuming the Government is prepared to follow up platitudes about the value of general practice with funding that works.

It’s not easy capturing a system in flux, especially when sector headlines seem to rewrite themselves every few days. But alongside a daily online news service, a monthly newsmagazine can act as a steady lens; capturing and illustrating a fast-moving picture and allowing us to pause and consider. I hope you enjoy the new incarnation of New Zealand Doctor Rata Aotearoa.