Spam Journalism #35

Spam Journalism: The spurious use of sensational headlines to add spice to an otherwise pointless article. (MacDoctor definition)

Health is always a ripe place for sensationalism, but this particular article elevates pointlessness to an art-form.

Debts make cuts in health services likely

“Wairarapa health services face an uncertain future after revelations the region’s district health board has blown its budget by $2 million, with officials refusing to rule out service cuts.

“The financial blowout comes just four years after the region’s former health boss, David Meates, told Parliament’s health select committee that the board forecast surpluses once the $30 million hospital opened.”

Reporting that a DHB is in debt and may be considering cutting back on some services is akin to reporting that there was a lot of traffic on the Auckland Motorway at 8 am this morning. Virtually every DHB, CHE and Health board has reported a deficit since the dawn of time. The same thing happens in every country that has a public health system. Governments have been tipping money over the event horizon of medicine for a hundred years and there is simply never enough. Health spending always rises to meet the budget, then sneaks over. 

The reason for this is most likely due to the massive asymmetric information inherent in medicine. Put simply, there are so many things that we don’t know, so we tend to spend masses of money minimising risk rather than treating patients. Doctors and nurses will often work in highly inefficient ways because this is familiar or perceived to be safer. Managers will cut inappropriate parts of a service because they do not understand the complexities involved. Often those complexities are not obvious to medical staff either, as they do not have the training to understand economic and managerial issues.

Added to all of this is the problem of unpredictable demand. An area may have a need for 500 hip replacements a year but be providing only 300. It takes a couple of years to arrange the funding and personnel to do the 500 hip replacements a year. By this time the need for hip replacements has fallen to 350 (or risen to 700), but the need for cardiac bypass grafts has increased from 400 to 600 so you start looking for funding for these… Some of this is predictable with rising population and rising age, but much of it is not. What, for instance, was the cost of revamping our pandemic readiness in the face of swine flu – an entirely unpredicted cost which also resulted in no gain in productivity (i.e. will be viewed as money “wasted”)?

None of this is new. This is no amazing insight from the MacDoctor. It is well-known to government (just not really appreciated by the public). It is therefore with some amusement that I read the line “David Meates told Parliament’s health select committee that the board forecast surpluses once the $30 million hospital opened“. I’m certain everyone on the select committee whispered “yeah, right” under their breath when he said this. 

It is said that nothing is certain except death and taxes. Although it would lack a certain pithiness, we could add DHB debt to that list.

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