I, like many New Zealanders, feel proud and very fortunate to have a universal tax funded healthcare system that means kiwis can largely access healthcare without having to pay for it directly. But the reality is that this care must be paid for by someone and as a country we are currently failing to adequately fund our health system.
Health funding, at 21% of government expenditure, is the second highest category of crown expenses and at over $16B spent in the year ending 30 June 2017 is the equivalent of 6% of New Zealand’s GDP. While this may appear to be a significant investment, New Zealand funds less healthcare per capita than a number of OECD nations including Australia, the United Kingdom, Canada and most of Scandinavia.
Given the finite level of funding available it is unsurprising that District Health Boards (DHBs) and organisations such as Pharmac need to make difficult funding choices to work within the constraints that are presented to them. Recent examples from many DHBs highlight significant infrastructure, equipment failure and budgetary issues, reportedly driven by chronic underfunding.
It’s easy to get lost in the blame game as the previous and current governments attempt to deflect attention across the aisle. The reality is this is a longstanding issue fuelled by the system’s complexity and our prevailing ideology regarding “free healthcare”.
Currently New Zealand has 20 DHBs servicing a population of a little less than 5 million people. I question along with others, whether this number of DHBs is necessary. Most use different systems and processes leading to inconsistencies in treatment at a national level and a poor experience for patients who move between DHBs. Reducing this complexity and centralising more services would go a long way towards improving outcomes and relieving budgetary pressure.
Additionally it is time we as a country acknowledged the greater role the private health sector could play in relieving some of the burden. The private health sector performs particularly well in the area of elective surgery, one where the public system consistently struggles, and is constantly building further capacity to deliver more services.
Private health insurance plays a key role in supporting the wider private health sector and helps avoid the constraints represented by finite government funding. It is a way that those who choose to (and can afford to) can take more responsibility for their own healthcare needs. My parents live within the catchment area for Counties Manukau DHB and I am thankful they have retained their health insurance. If they do require non-emergency healthcare at least they won’t receive their care in buildings of “high concern“.
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