The National Party's Monty Python health (non) reform is a comedy. In order to cut layers of management, new layers are being introduced. First, old man Levy, who was Key's buddy at the Auckland District Health Boards, has been brought back to be the super-duper CEO boss of existing Health NZ CEO boss, Fepulea’i Margie Apa (CEOs seem to now need CEOs above them to manage them). Four new "Deputy CEOs" have just been appointed below Apa to manage each of four regions NZ has been divvied into. The South Island is classified as one region - apologies to Otago & Canterbury. The funniest part of National's Health Minister Reti's "plan" to get health back on track is that neither CEO Apa, nor a single one of her Big Time Deputies, is a doctor.
The philosophy seems to be, "What would a doctor know about health?" Apa has a BCom in management from Auckland University, in which not a thing about how the health system works is taught. What's most amusing is how Minister Reti is trying to portray these moves as a profound reform in which more power is being returned to regions. Bollocks. Both National & Labour supported abolishing the 20 District Health Boards that existed in 2020 to "centralize" health-care. The only difference is National argues the system should not be quite as centralized as Labour wants. Big Deal.
Both parties are sadly pushing to keep our existing single public payer-single public provider system intact (bar a limited role for private provision). Whether one decides to have it administered by 20, 4 or 1 Board wont change service quality. My preferred (quality enhancing) reform is to run health-care along similar lines to how our General Practitioners, medical laboratory-testing and Pharmac are already working. That is, the government would not only negotiate prices for GP services, lab-tests and drugs, but hospital medical procedures as well. Private & public hospitals then compete on quality to provide services at those agreed prices. Patients, in consultation with their doctor, choose where to go - the place offering the best, fastest quality treatment. High quality hospitals expand; low quality ones contract. The winner is the patient. The gov't pays the bills. Its a single payer, multiple provider (many of which are private) model. If you think it is a theory, it is not. It is already successfully running abroad (not in the US, which features private insurance) where NZ style systems (as supported by National & Labour) have been dumped. If you think private health suppliers can't be trusted, think again. Kiwi GPs already run their own private business; each drug you use, bought by Pharmac, is already privately produced. Medical tests in NZ are already done by private suppliers. The bills are already picked up by the gov't. Luxon better get his head around the idea of centralized payment, yet far greater decentralized (private hospital) provision fast or our system will implode. His current plans (based on calling all sorts a CEO, like he was) will go nowhere in the public sector. National needs imagination.
Professor Robert MacCulloch holds the Matthew S. Abel Chair of Macroeconomics at Auckland University. He has previously worked at the Reserve Bank, Oxford University, and the London School of Economics. He runs the blog Down to Earth Kiwi from where this article was sourced.
Professor Robert MacCulloch holds the Matthew S. Abel Chair of Macroeconomics at Auckland University. He has previously worked at the Reserve Bank, Oxford University, and the London School of Economics. He runs the blog Down to Earth Kiwi from where this article was sourced.
2 comments:
The South Island introduced NOW as a separate Zone would be an ideal entry into the future NZ centralised payment system. It is not a big step if the South Island became a single payer multiple provider without the layers of NZ medical bureaucracy.
Maybe the UK reform Party system of a contract between a NZ Political party and citizens for health services would encourage centralised payment in NZ
Does it not occur to anyone that maybe the Commissioner has simply appointed 4 people he can trust rather than rely on the existing management who would, on the evidence to date, seem to be as useless as they are obstructive.
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