MacDoctor » Kiwiblog

The $3 Shop

MacDoctor — Fri, 16 Jul 2010 10:24:47 +0000

The MacDoctor often refers to the pharmacy as the $3 shop (All funded script items cost $3.00). And, yes, patients often stare at him blankly, but one has to get one’s fun from somewhere. A recent Herald article claims that this fee is sometimes too much for low-income people causing them not to pick up their prescription. Actually, the research was done in 2004 when the script fee was $15.00 per item and was instrumental in the fee being dropped to $3.00 per item across the board, rather than for community service card (CSC) holders. Note that this was partly because a significant number of low-income people did not apply for the CSC; usually out of pride, sometimes out of ignorance.

Applying that research to today is therefore extremely dubious.

The script fee is essentially the pharmacist’s profit for dispensing funded medicines on behalf of the government. Most of it is now paid for directly by the taxpayer. There is no particularly good economic reason for retaining the $3.00 surcharge. The amount generated is relatively trivial and mostly swallowed by increased processing costs. In addition, it does not prevent overuse of medicines as a true part-charge may. All funded items must be prescribed by a doctor. I can tell you for certain that no doctor considers the script charge when prescribing drugs. The primary reasons why you would want to keep the number of script items down is that:

People are less likely to take their medicine if there are a large number of items (two or three seems about the limit).
The chances of an unexpected interaction between medicines increases rapidly with each additional script item.

A $3.00 script fee is not even a distant third.

This means that the script fee could be easily removed with no sudden blow-out of Pharmac’s precious budget. Unfortunately, this will almost certainly make only a small difference in the number of scripts that are not collected. Almost every large town and city has pharmacies that waive the $3.00 script fee. Whatever the percentage of patients in 2010 who claim that they can’t afford the script charge, that percentage is largely a proxy for lack of transport (if they had access to transport, they could get their scripts for free). While there are many reasons why people do not collect their medication, the predominant one has always been lack of transport. The other major reason is pride. WINZ is more than happy to provide temporary funds for medication. People simply do not want to ask.

A small percentage of people may not fill their script because they feel the doctor has not explained what their medicines are for. MacDoctor’s advice for these people is: find another doctor.

Occasionally, certain people are interested only in the sick note provided – never wanting treatment for their cold/flu/back pain/nausea etc.

Removing the script fee may assist some people whose GPs are within walking distance of a pharmacy that currently does not waive fees. These numbers are not large but, as the cost of removing this fee is likely to be marginal (when processing costs are taken into count), it is probably a worthwhile thing to do.

Extra bonus point for Mr. Ryall. Labour would hate it.

Additional:

I see David Farrar has also blogged on this.

So 94% do manage to pay the $3 charge. To me that suggests that rather than scrap the fee for everyone, you look at targeting assistance to those on the lowest incomes or greatest health needs.

Been there, done that. Some will still slip through the cracks, just as they do for the CSC. The fee is already pretty much worthless. May as well scrap it entirely.

And, as usual, DPF’s comment trolls suggest that, if people can afford smokes and alcohol, they can afford a script fee. May I remind them that the vast majority of medical transactions are unplanned. People spend their money on smokes THEN get sick and need medication. And planning ahead is what these people do worst – that is usually why they are poor…

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Booze Scoop

MacDoctor — Thu, 22 Apr 2010 11:51:52 +0000

David Farrar appears to have scooped the newspapers with a leaked version of The Law Commission proposals on alcohol. The Stuff version is here. David’s summary runs:

A massive 50% increase in the excise tax on alcohol. This would result in an extra $500 million of revenue to the Crown at the expense of everyone who drinks.

Banning the sale of liquor at off licenses after 10 pm. So if you pop into New World at 10.30 pm to do your shopping (which I often do), you won’t be able to buy a bottle of wine.

Forcing bars and nightclubs to refuse to allow people to enter after 2 am.

A nationwide closing time for all outlets, probably at 4 am.

An increase in the purchase age for alcohol from 18 to 20, criminalising 130,000 18 and 19 year olds if they buy alcohol.

Apparently the report runs to over 500 pages. Presumably because they have to use big print so that politicians can understand it.

MacDoctor has a far simpler proposal.

Firstly, while Bill English may like the idea of a 50% increase in alcohol taxes, he should seriously consider an increase of 300% on RTDs. Ready-To-Drink mixes are the equivalent of Pina Coladas to tourists. Fun, easy to drink and dangerous. Kids will still get drunk if they can’t afford them, but at least they will know that they are drinking real alcohol, not a fizzy drink.

But that is not the proposal.

The real proposal is that all liquor outlets (bars, restaurants, supermarkets, liquor stores) have a mandatory breathalyzer test for anyone buying alcohol. If you blow more than 0.08%, it is illegal to sell you more alcohol. You are welcome to buy more alcohol before you are drunk, with the sole intention of becoming wasted, but no-one will sell you alcohol after you reach the magic limit. In addition, it will be illegal to supply anyone with alcohol after they reach 0.08%. If you are caught supplying liquor to such a person, the cop will check the BAC of the receiver and then arrest you, if the level is more than 0.08%.

Why 0.08%? No particular reason. I just want to take away the fuzziness of the current “illegal to serve intoxicated persons” law and make it concrete. Yes, there will be some at 0.08% who are in considerably better shape than someone else with a BAC of 0.05%, but that’s just tough. Most people at below 0.08% will still be reasonably sober.

No need to close bars early or cut off aisles in the supermarket. No need to raise the drinking age. Just make sure that the current laws are followed by making the limit concrete.

Just let me know before you decide to make this law, so I can buy shares in a portable breathalyzer manufacturer.

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Climate Control

MacDoctor — Mon, 10 Aug 2009 11:49:22 +0000

David Farrar has produced this lovely piece of satire:

The Green Party today released a further policy on how New Zealand can make a goal of a 40% reduction in carbon emissions by 2020 and 80% by 2050.

“We realised our previous policy of de-stocking dairy herds was not going to be enough. Yes Cows fart and belch more methane than humans, but they don’t travel in cars and use heaters” said the Green Party.

New Zealanders emit 7.4 metric tons of carbon emissions per capita. The more New Zealanders we have, the more emissions we have. Hence the solution is to have less New Zealanders”

We have decided abortion is the best way to reduce the number of New Zealanders, as this is preferable to euthanasia. In 2007 the abortion rate was only 22.2% of pregnancies. If we can triple that to 67%, that will mean 37,000 less New Zealanders every year.

I was amused until I remembered the controversy about the Green’s population policy. Exactly what do they mean by ecological carrying capacity and how will “Informed decisions about family size and spacing” be “made by the parents concerned”? I wonder just how far David’s satire is from reality…

Vote for just me.

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Not Even Animals

MacDoctor — Fri, 15 May 2009 23:44:53 +0000

The horrific details of the murder of Duwayne Pailegutu by his stepfather, Johnny Pukerua Joachim have been released. They make grim reading.

Johnny Joachim is serving an 18-year, non-parole sentence after admitting Duwayne’s murder.

For the week before he died,Duwayne sat, partially paralysed and fitted with nappies, slowly suffocating on blood which he inhaled into his lungs as he vomited during “exercises” in which his stepfather made repeated blows to his stomach to make him cough up blood.

In an attempt to “shock” Duwayne into movement, Joachim dipped his paralysed foot into boiling water, leaving the largest of four scald wounds on his right leg.

When he became frustrated that Duwayne could not move, Joachim threw him against a wall.

David Farrar mourns the fact that that shares a species with this animal. Frankly, I think this man left the human race long ago. I would hesitate to even classify him as primate as even baboons take better care of their young.

I thought that the shocking treatment of Nia Glassie was the depth of depravity.

It seems I was wrong.

Eighteen years is far too little.

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Carbon Guessing

MacDoctor — Wed, 15 Apr 2009 05:51:16 +0000

I note that our Kyoto liability estimate seems to have swung into surplus after a number of years in the red. Of course, this has absolutely nothing to do with our actual carbon dioxide emissions and everything to do with the ridiculous way we attempt to calculate these emissions. Apparently our new “surplus” is due to our reduced farming of livestock because of the drought and some new information on carbon storage in forests. In other words we are doing well because our number one source of income has deteriorated and because of new information which, had it not been discovered, would have had us paying a much greater amount than we needed. Surely this speaks volumes about the stupidity of the Kyoto Protocol? Damaging our economy because we need to curtail emissions is one thing but damaging our economy because the Kyoto calculation is using the wrong facts is utterly dumb.

I also wonder how much of the calculation is politically driven, rather than a genuine attempt to determine our current carbon production? I note that while Labour was trying to promote the Emissions Trading Scam Scheme, the liability was sitting at a billion dollars (quick, quick! we must pass this without thought because of this enormous imaginary liability!). When that amount became a bit of a whipping boy for National to use against Labour, it miraculously dropped to half the amount. Now National, who do not wish to repudiate the protocol, have amazingly produced a surplus, by abandoning the ETS! Perhaps we should build lots of coal fired power stations and blow up the wind farms. That would really get our Kyoto liabilities down!

It is amusing that Nick Smith attempts to grab the credit for National by suggesting that the new surplus is due in part to the 600,000 acres of forests planted in the 1990s when National was last in power…

David Farrar points out that the ETS was simply about a stealth tax, anyway. Homepaddock ponders the implications for farming and Whale oil decides it is all a matter of fertiliser.

Meanwhile, the MacDoctor has given this matter some thought and would like to suggest that the simplest way of reducing our carbon emissions is to remove the largest generator of warm carbon dioxide in New Zealand.

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