User-pays Health

By Jim McVeagh 23/01/2010


Dr Chris Jackson is a brave man. He has suggested a scheme which would allow oncology patients access to privately funded services at public hospitals. It is, of course, an excellent idea. It is also an idea that will attract vilification from his colleagues (especially the doctors unions) and the Left (who hate the idea of better health services going to the wealthy). This is not to suggest that there are no disadvantages to the idea of private services in public hospitals there most certainly are cons. Christchurch Hospital medical staff association president, Dr Ruth Spearing, points out the first one.

Spearing said she had experienced a public-private system in Britain, and it did not work well. Fee-paying patients would get better treatment or bumped up lists ahead of non-paying patients, she said.

The essential problem in Britain is that the hospitals can do only so many procedures a year and private patients essentially buy their way up the British waiting lists. Allowing the wealthy to delay the elective treatment of people on the public list is simply not acceptable. What needs to happen to obviate this injustice is to ensure that the elective lists are maintained totally separately from the private lists. If the government has purchased 400 hip replacements from a DHB them 400 hip replacements should be done for public patients. If another 30 pay for their own hip replacements then the DHB will have done 430. This is to everyone’s advantage. The patient who gets their hip replacement early, the DHB, surgeons and nurses who get paid extra and even the public patients who may well wait less time (30 fewer to compete on the lists).

The second difficulty is one that I have blogged about. It is essential that the government eliminates any unfairness in its funding levels for a particular procedure before allowing private work to be done in public facilities. It is not acceptable to be engaging in private work if the funding model seriously disadvantages one DHB over another. All DHBs should operating either at maximum current capacity (necessitating them to add capacity to accommodate private work) or, more likely, all DHBs should be operating at maximum funded capacity (the maximum the government is willing to pay for). It is not acceptable to be producing an inadequate number of public elective procedures and then go looking for private work.

The third caveat is that development of private services in the public hospital system should be complementary to the private system and not in competition with it. It is pointless building private capacity into the public system if there are private facilities available. New Zealand cannot afford this kind of duplication of facilities. The first article cited gives an excellent example:

An Invercargill man, who has non-Hodgkin’s Lymphoma, said not having to travel out of town to access his courses of Rituximab would be a huge bonus.

Spending $5520 every three months for the non-government funded portion of the treatment, combined with travelling to the Marinoto Clinic in Dunedin to have the drug administered, was inconvenient and expensive, he said.

While he conceded he would still have to pay for the drug if it was administered in Invercargill, cutting out the private clinic and travel costs, which were upwards of $400 each trip, would be great.

“I don’t understand why I can’t buy the drug from the Southland District Health Board, go into their unit and they just plug me in and give it to me,” he said.

Here is a great example of how a small extension of the public hospital can enable this gentleman to get his expensive, self-funded chemotherapy given to him locally. It is a disgrace that he has to travel to a private clinic in Dunedin for this and it is a prime example of the triumph of ideology over common sense.

And speaking of triumphs of ideology over common sense, the completely gormless Ruth Dyson has this to say on the subject:

Labour health spokeswoman Ruth Dyson said people should be able to access services in the public health system on the basis of their medical needs, not their wealth.

The idea that paying patients would not queue-jump or be given preferential treatment was “simply not credible”.

The first statement is simply irrelevant. People will not be accessing public health services through their wealth, they will be accessing private services, just performed in at a public hospital venue. The second statement is a typical Labour knee-jerk ideology reaction. It would be relatively simply to avoid the pitfalls I have outlined above and a long way from being “simply not credible”.

This idea has much merit. It promises to deliver better services all round, including shortened public waiting lists. It promises to provide some additional funding for the DHBs making it less likely that the government has to bail them out of deficit with our tax dollars. For people like the Invercargill man with non-hodgkin’s lymphoma, it promises relief from enduring a 2.5 hour drive home after a dose of powerful chemotherapy.

The only real downside will be that Labour will look stupid for blocking it all these years.

Come to think of it – no real downside.

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