Show Me the Technology

The Dominion Post writes yesterday about the looming shortage of oncologists. Four cancer doctors have resigned in a very short space of time. The article explores all the usual reasons why doctors leave, particularly the worrying ones of overwork,  which can only be fixed by employing more hard-to-get doctors. What struck me, though, was the last line – well second-to-last. The last line was Tony Ryall’s spokesman passing the buck to the DHBs – not a good look. Anyway, that second-to-last line was:

“He was leaving the public system because he could provide a higher standard of care through a private clinic. “We have the opportunity of getting state-of-the-art machines without having to wait 10 years.” (emphasis mine)”

While it is true that non-specialists tend to leave the public health system due solely to money issues, this is not true of specialists. Sure, they do earn a lot more in private practice and their hours are often better, but a very strong motivation is the provision of far better facilities. This would be particularly important for people such as oncologists whose results are often very dependent on the quality of equipment and drugs they have access to. However, I have heard the same comment from many specialists of my acquaintance who have moved from public to private practice. It is no accident that laparoscopic surgery was performed in private practice long before it came into public hospitals, despite its overwhelming superiority to standard surgical procedure in terms of recovery, cosmetic result and, at the end of the day, cost to the patient (or the taxpayer) due to lower length of stays.

Even specialists with private practices working in public facilities often comment that what they do in state health is necessarily inferior to what they can achieve in private.

This is a problem in capital expenditure. Tony Ryall has already indicated that the government can only afford about a third of the capital requests before it. Therefore this problem will simply get worse. The only two solutions are:

• increase capital expenditure ( not viable in the current economic environment)
• use the equipment available in private practice

It seems clear to me that there are some areas that will eventually be mostly managed in private practice with the state system providing basic support and, of course, funding. Oncology seems the most likely candidate for this migration with radiation treatment almost certainly moving out of the state system as it becomes next to impossible to justify the high capital costs of parallel state/private systems. This is also directly pertinent to the debate on private practice using state facilities.

New Zealand is a small country. We simply cannot afford to run two expensive medical systems side by side. At some point we are going to have to move away from the ideological block we have against private medicine and allow a mingling between the two systems and a sharing of expensive resources. This is an inevitability unless we wish to see our health statistics slide inexorably down the WHO league tables.

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