User-pays Health
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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- Ethics vs politics « Homepaddock — [...] Macdoctor supports the concept and the panel discussed the issue with Jim Mora and Dr Jackson (at about 15:30). [...]
Jan 24 10 9:41 am
Sounds good but the fly in the ointment is that it may only be feasible to do 400 – given the number of operating theaters, staff, hospital beds etc etc etc all with competing claims for use. And that is even before we consider where the Orthopedic surgeons who perform these “extra procedures” are to come from.
Jan 25 10 9:59 pm
Andrei: the fly in the ointment is that it may only be feasible to do 400
True. But the point is that, unless we have the capacity to do 400 public operations and can safely increase our capacity to accommodate a further 30, we have no business in soliciting private work for public hospitals.
Orthopaedic operations are a poor example, anyway, as they require substantial extra resources to do. Dr. Jackson’s proposal is a very simple one – expanding oncology facilities to accommodate private patients is relatively simple compared to increasing operative throughput.
Jan 24 10 2:14 pm
Heck, just over a year ago I couldn’t buy private services in a *private* hospital when I wanted to. I was waiting in a public hospital for ten days just to get a PICC line put in – I needed large amounts of antibiotics intravenously for six weeks (post-op bone infection). All this time I was losing money – I’m self-employed. I asked the specialist if I could go down the road to the local private hospital and pay to have it done, and he told me that’s illegal. If I could have gotten out of there and back to work I’d have been a much happier bunny.
Jan 25 10 8:42 am
The reality is the government cant afford to pay for all treatments for everyone. And more and more drugs are coming down the pipe which we will not be able to get access to in the public system, especially life saving cancer drugs. But to go private you have to have thousands and thousands of dollars as you’ll need to pay for all your treatment in private – even that you would have got free in public (you cant switch between public:private in most DHBs, it’s all or nothing). So only the very rich can get these drugs – the two tiers are way apart. Dr Jacksons scheme sounds right on to me – it’s a way of making the non-government funded drugs more affordable for more people – You still get your public treatment free, and just pay for the top-up. It’s a no brainer.
Jan 25 10 1:17 pm
Does it not potentially make the entry into market, and competition, for genuine private providers even more difficult?
Shane Pleasance´s last blog ..It is already our hospital.
Jan 25 10 9:58 pm
I’m sure you are right, Shane. That is why I said that it is important that private services in public hospitals are not set up in direct competition to local private providers. This would be unfair competition.
Jan 27 10 11:07 am
You say that the idea of public/private services being provided in cooperation is a good one, but I wonder if you know of any examples where this is actually working today?
How would you ensure that private patients don’t force staff to give them better care than public patients, and how would you ensure that those who have a financial interest in private patients don’t profit to the detriment of those funded under the public scheme?
Also, how would you deal with the income gathered from private patients – how would you ensure it was used in a fair manner.
I like the idea of being able to bring more money into the hospital I work at, but from my experience, DHB’s are slow to change and there are a lot of competing self-interests involved at all levels. I don’t see how you could factor them out and still end up with practical and useful cooperative services.