Who cares about healthcare?

Warren Lindberg
Chief Executive OfficerWarren L 200x300
Public Health Association

Health is perennially near the top – if not number one – of election issues.  This year it’s outclassed by poverty, housing and immigration.

John Campbell’s dogged interviews with Health Minister Coleman on Checkpoint last week illustrate how health is debated at political level, with familiar issues aired such as waiting times, bed shortages and budgets. Familiar positions are struck – Campbell quoting complaints from the public and clinicians, Coleman defending the extent of funding and blaming hospital management.

Catherine Woulfe’s investigation into rheumatic fever in the Listener (Fever pitch, July 21) exposed a different argument.  Wellington medical school researcher Ramona Tiatia reported how a lot of parents feel they’ve failed their children when they’ve seen the TV ads advising ‘Rheumatic fever – it starts with a sore throat’. “The ramifications of heart surgery and a short life-span are devastating for parents”, Ramona advised. Woulfe’s investigation focused on medical research into other possible triggers for rheumatic fever, such as skin sores. But whether that proves to be the case, the underlying determinants remain poor housing: damp, cold and over-crowded. Tiatia went on to point out that the parent’s sense of guilt is compounded when these environmental determinants are pointed out.

In the same article, Whangarei paediatrician Roger Tuck is reported as likening the ($65 million) sore-throat swabbing programme to “chucking people who are floating down the river a life-jacket.” Clinicians like Tuck are increasingly joining the chorus of public health researchers and activists demanding that government shift attention from blaming the victims to addressing the question of where responsibility for the wider determinants of ill health should lie.

So when poverty and housing are top of election issues – so is health. The Minister is correct about one thing at least – a lot of money is spent on health. But Campbell’s and Dr Tuck’s questions are also on target: is it enough? and is it wisely spent?

Some data pointing to answers comes from a study carried out since 1998 by The Commonwealth Fund (a private US foundation), titled Mirror, Mirror 2017’.

The report’s purpose is to compare the US health system with ten other high-income countries to “reflect flaws and opportunities for better US healthcare”. It begins by noting that the “US spends far more on health care than other high-income countries… Yet the U.S. population has poorer health than other countries.” In spite of spending 16.6% of GDP on healthcare, it ranks lowest on outcomes such as infant mortality and adults living with chronic conditions.

NZ’s proportion of GDP spent on health is 9.7%, ranking fourth out of the eleven countries, a bit more than Australia’s 9% but less than UK’s 9.9%.  In its previous report, Mirror, Mirror on the Wall, 2014 Update, The Commonwealth Fund compared per capita expenditure instead of GDP.  That placed NZ as the cheapest health care system in the high-income world at $3,182, compared with UK $3,405, Australia $3,800 and Sweden $3,925 – with everyone else spending more than $4000.  So while GDP might not be a critical factor, our low per capita expenditure suggests we could spend more.

More importantly, NZ is ranked 2/11 on administrative efficiency (that is, how much time is wasted by clinicians on bureaucracy!) and 3/11 on the care process. That is, what health professionals do every day to care for patients, and includes preventive activity such as screening, immunisation and brief interventions such as ABC for smokers.

But we drop down the list to 7/11 on access and outcomes, and 8/11 on equity.  This reflects out-of-pocket expenses such as prescription co-payments, cost of dental care, and waiting lists; and disparities for Māori and Pasifika, based on accessibility, affordability and cultural acceptability.

Shouldn’t we be ashamed?

This blog has been contributed by a member of the ComVoices network

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