New Zealand’s health system is a political football, held together only by the high quality of our nurses and doctors, according to a new book – Health Cheque from Gareth Morgan.
While the local health system scrubs up surprisingly well globally, Dr Morgan finds a substantial mismatch between the public’s expectations and what the health system actually delivers. Co-authored with former Treasury analyst Geoff Simmons, Health Cheque asks the tough questions including why the system won’t vaccinate Porirua toddlers but is happy to give a coronary bypass to a 90 year old Remuera spinster.
From interviews with those working in the sector through to a detailed examination of the latest major review of the system known as the Horn Report, Morgan and Simmons go behind the scenes of the New Zealand public health system and bring clarity to the issues that need to be addressed if crisis is to be avoided.
The book explores the consequences of ongoing avoidance of the tough calls on rationing and prioritisation. It considers how many New Zealanders are already suffering or missing out from health care because of ad-hoc interventions in response to pressure groups. Written in Morgan’s frank style, this book takes no prisoners as it explores which patients and treatments need to be given priority.
Health Cheque’s findings on the state of public health may be a bitter pill to swallow, but the diagnosis of the ills, and the medicine Morgan and Simmons prescribe, will benefit us all.
Chapter One: Evolution and Revolution
How we got our present public health system. What is a ‘public health system’, and who needs one? The origins of the system in Michael Joseph Savage’s nationalisation in 1938; the evolution of the system prior to 1985; revolution and counter-revolution, 1985-2009.
Chapter Two: What Cost Health?
How our present system works — how it’s funded, what it delivers, and how it compares with other developed countries.
Chapter Three: Your Health, New Zealand
New Zealand’s vital statistics: how do our rates of sickness, health and morbidity compare with the rest of the developed world? Does the public health system deserve the credit, or the blame?
Chapter Four: What Gets Funded
Given the existing constraints upon the health budget and the likelihood that these will get tighter, we need to be more open about the rationing of care. So what do we want from our public health system? How do we decide what treatments should be funded?
Chapter Five: So Who Gets Treated?
You can’t always get what you want. Once we decide what to fund, how do we choose which patient gets the treatment and which patient misses out?
Chapter Six: Past, Present and Future — Health Sector Trends
Where is the health system heading? This chapter looks at the trends in the health sector — the pressures that bear upon the health system (rising expectations, ageing population, the global market for health employment, the soaring cost of treatments) with a view to seeing what the system will look like a few decades hence?
Chapter Seven: Lets Play Doctors and Nurses
The biggest problem that people working in the sector identified was the workforce. Previous governments haven.t considered planning for health sector workforce requirements to be necessary or desirable. That’s got to change. So how do we do it?
Chapter Eight: Too Many Chiefs and Not Enough Indians?
Given it is health professionals, doctors and nurses, who make the calls that ultimately determine how the health budget is spent, how do you set up a system of administration that helps rather than hampers them in doing their job?
Chapter 9: Can We Save It?
In light of all we’ve discussed, what is the New Zealand citizen to do about their health care, both in terms of making practical arrangements for themselves and their families, and on Election Day? Gareth Morgan is CEO of Gareth Morgan Investments, portfolio manager, and chairman of economics consultancy Infometrics Ltd that he founded in 1982. He is also a well-known columnist, philanthropist and author. Geoff Simmons is an economist for the Morgan Family Charitable Foundation and has previously worked for the New Zealand Treasury. He is also Co-Creative Director of the Wellington Improvisation Troupe.