Our proud, yet troubled, public health system

 

 

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“.

Picture credit: Unsplash.com

Does private health insurance help or hinder New Zealand’s health system?

Recently I was asked whether private health insurance helps or hinders the public health system and my immediate reaction was “of course it helps the public system by….!”

But putting that initial gut reaction aside, I put myself into the shoes of those working in the public sector and started to question whether we do in fact encourage top surgeons to move out of the public sector. Does the presence of the private sector contribute to further inequities in health outcomes?

It is generally accepted that surgeons are paid more in the private sector than in public, and it could be argued this disparity could be discouraging surgeons from working in the public sector. However, what we are really seeing is that most surgeons working in a private setting also continue to work in the public sector. Arguably the higher pay rates they can command in the private sector subsidises their public earnings, thereby keeping world class surgeons here in this country.

Retaining quality surgeons in both the private and public sectors should be a key priority for maintaining the high standards of healthcare in this country and is a way that private health insurance can support the public health system.

Private health insurance contributes more than a billion dollars to the health sector annually and this money is often used by private sector providers to partially fund the introduction of emerging technologies such as PET scanning, robotically assisted surgeries, and development of facilities to manufacture radioactive isotopes used in diagnostic imaging across both the private and public health sectors.

New Zealand’s two tiered health system does introduce overall inequities where some people are able to afford a wider range of health services than others. However, health insurance can also help to reduce inequitable outcomes by encouraging those who can afford it, to take greater responsibility for their own health needs. By paying for around half of all elective surgical procedures in New Zealand, the private sector frees up public funding to deliver greater benefits to those who cannot afford private health insurance premiums.

Overall the public health system in New Zealand does a fantastic job but does have its limitations, particularly with regards to elective procedures. Private health insurance has a place in complementing public health services by picking up some of the slack in this elective surgery area, helping to fund innovation that benefits all New Zealanders and encourages those who can afford to look after more of their own health needs to do so.

Not all breast cancers are created equal

One in nine New Zealand women will be diagnosed with breast cancer over their lifetime giving us the 7th highest incidence rate of this disease in the world. I was fortunate enough to attend a summit hosted by Breast Cancer Cure, New Zealand’s only not-for-profit organisation solely dedicated to finding a cure for breast cancer through research. The summit featured leading oncologists and researchers talking about the very complex nature of breast cancer and how to treat it effectively.

Having worked in the private health insurance industry for more than a decade I was surprised by how much I learned over the course of this day with the real stand out for me being that all breast cancers are not created equal. The disease differs from woman to woman depending on a host of complex genetic factors and the key take away for me as an insurance professional, and as a woman, is the importance of early detection.

Genetic factors

An important factor in successfully treating breast cancer is first identifying exactly what sort of tumour a patient has. One of the key differentiators between tumours is how they respond to oestrogen. Approximately three quarters of breast cancers in New Zealand are hormone responsive tumours. This means that the hormones a woman’s body creates impacts on the rate at which her tumour grows and spreads, therefore treatment to reduce or remove the production of these hormones is helpful in fighting the cancer.

Another variant are triple negative breast cancers (TNBC) that represent about 15% of breast cancer diagnosed in New Zealand and tests negative for all three receptors (oestrogen, progesterone and HER2). These cancers tend to impact younger women and have very limited treatment options.

In addition, another important variable is whether the tumour is HER2 positive or negative. HER2 positive cancer is generally more aggressive than HER2 negative and as such requires more targeted treatment such as Trastuzumab (Herceptin) used in combination with more traditional chemotherapy.

Early detection

It is easy to feel helpless in the face of genetics, but overall the strongest message throughout the day was how important early detection is. Patients diagnosed with breast cancer at stage one, irrespective of their tumour’s genetic type, have far higher survival rates as the disease has not yet spread. Conversely being diagnosed at stage four is a grim prospect.

Regular screening is an important factor in diagnosing cancers before they can be felt and all women, especially those not yet eligible for publically funding screening should be checking themselves regularly. Our Private Health Plus product offers a contribution towards regular screening and comprehensive cover for cancer care should a diagnosis unfortunately occur.

Pic credit: William Bout, Unsplash.

Living with bowel cancer

Working in the insurance industry means that you get very comfortable talking about things that other people find quite confronting, things like dying, becoming disabled or developing cancer. One topic that a lot of people really don’t want to talk about is bowel cancer and I can understand why. It affects an area of the body that isn’t usually discussed in polite company and the on-going impacts on people’s lives aren’t for the squeamish.

But bowel cancer kills more people in New Zealand than breast and prostate cancer combined so it’s time we started talking about it. Given its bowel cancer awareness month I wanted to share my story as I live with its effects every day.

My partner developed bowel cancer in his twenties (he is now in his forties) which was successfully treated surgically with no need for chemotherapy or radiotherapy. I’d love to say this is where the story ends, but it doesn’t. Due to the nature of the surgery he had he has on-going effects every day and is also subjected to regular invasive surveillance procedures.

Because he had almost his entire large bowel removed he has to take medication every single time he eats. The medication is designed to slow down his digestive system so if he doesn’t take it an evening out ends pretty quickly. This means I have to keep a good supply in my handbag just in case he forgets his pills. On the other hand though, if he takes too many pills he can get a painful bowel blockage.

We’ve also had to go to the hospital in the middle of the night a few times when he has suffered bowel obstructions brought on by the scar tissue surrounding his intestines and remaining large bowel. Thankfully he has never needed surgery to correct this but I’m scared that one day he will.

Because he developed bowel cancer at a very young age and his father died of it in his fifties, he needs to have regular monitoring. This means every two years he has a colonoscopy, every four years a gastroscopy and at times when his on-going pain has gotten really bad, MRIs to see if there is anything else going on. Every time he goes in for these checks I worry that this will be the time it comes back, or that his specialist will miss something or he’ll suffer some complication associated with the procedure.

So while my partner is cancer free, we will never really be free of bowel cancer.