Health: are we getting value for money?

Press, 30 August 1978, Page 31

Health: are we getting value for money?

By JOHN BROWN Is New Zealand getting value for the SIOOOM it spends each year on health? This question is taxing the minds of the tiny group of medical planners. An answer to it will drastically change the way in which future health votes are spent. Accountability, effectiveness and evaluation will be the name of the game in health planning over the next year. Plagued by a system which is spending too much, too ineffectively and too rapidly medical planners are being forced to accept the fact that consumers are not getting value for money. The State health sector spent SBOOM over the last year. More than S2OOM was spent by the private sector yet health care is still not getting to many .people who require it. Modem systems of health care are still largely denied to the country’s disabled citizens, many thousands of elderly people, large numbers of nonEuropeans and many new bom children. While the country’s

major hospital boards are embroiled in an almost indecent rush to set up expensive open heart units, body scanning facilities, bone marrow transplant units — ail of which would only £erve a small number of people — thousands of hospital patients must make do with substandard facilities in over crowded, poorly serviced hospital wards. With a sincere desire to defuse health problems the Government has set up, for the second year running, funding for community, based health care schemes. Hospital boards however are still the only major agencies available to control these and many question the wisdom of this process as the boards simply do not have the Experience or expertise tq gain the “feel” of community needs. Wedded to an institutional bias the boards can not be blamed if they become .confused at the sudden availability of community health funds. No national plan exists for this [funding therefore it is still, largely a hit and

miss approach which is forced on most boards. In one board last year a fleet of cars was purchased to use up the community health grant. That this step was taken is an indictment of short sighted health policies for so many other more urgent community health needs missed out on funding because of the step. While the country calls for new approaches to the care of its elderly citizens, hospital boards, with one or two exceptions still seem unable to realise that institutions are not the only answer. Lip service is paid to home care support for the elderly but most 60 year olds who require health care will still face the inevitable institutional care when they reach their 70s. The rapid growth of private medical health insurance schemes and the demands on government funding from the private health sector make a mockery of socialised medicine in New Zealand. The private sector are well aware that State hospitals and other health

agencies could not cope if they pulled out of the health care scene. Richly endowed private health operations sadly play on the inadequacies of the State system. It is in this confused arena that the need for evaluation and accountability is being nurtured. Doctors, from general practitioners to specialists, are well aware that only abcrut 10 per cent of all medical therapies have been properly evaluated. The public, increasingly better educated and more militant on health matters no longer accept as “gospel” the role of doctors or hospitals. Because the medical profession is being ques* tioned many hundreds of doctors are meeting the challenge by accepting a wider social responsibility. As many however still remain aloof, inaccessible and distant from the consumer. They argue, with some validity that the community has placed them on a pedestal and there they choose to remain. Blame for the piecemeal

state of the country’s health system can not be placed all at the feet of hopelessly unco-ordinated hospital boards, the bureaucracy of the Department of Health or the medical profession for the consumers themselves must take their share of the blame along with the Government past and present. While the consumers continue to drink and drive in almost total ignorance of the consequences, while they continue to smoke cigarettes as though they were a panacea for all ills, while they consume enormous amounts of alcohol then they must be forced to accept their share of the blame. On the other side of the coin however, the role of health professionals must also be questioned. If they really cared about the health problems then they would be seriously ques tioning the economic system which gives rise to life styles which are a danger to health. For example instead of just blaming the drunken

drivers health profess sionals would show more sincerity if they attacked those who made vast fortunes from promoting the sale of alcohol. In the present hysterical reaction to “hard” drugs and the clamour for tough anti-drug legislation health professionals and politicians seem to have forgotten the “pushers” of alcohol and tobacco — the most dangerous and widely used proven problem drugs. The consumer might be excused for asking why the country’s health system does not closely question this situation.