Health insurance taking focus off prevention?

Press, 7 March 1984, Page 8

Health insurance taking focus off prevention?

By

JACQUELINE STEINCAMP

Private medical insurance schemes are leading medicine towards high technology techniques and away from prevention and primary health care, according to Jill Nuthall, a medical social worker, who addressed the annual meeting of the Pan-Pacific and South-East Asian Women’s Association in Christchurch recently. “Once medical personnel are paid a fee for service by a third party and fees are set for each procedure, more people will receive surgery, more people will be treated in hospitals than as outpatients, and no money will be allocated to preventive programmes,” she said. Mrs Nuthall said that almost without oiir realising it, New Zealand’s health care system was being transformed into one based on the principle of “user pays.” “With the promotion of medical insurance schemes/ we are being led to believe that a sick person is responsible for paying for his or her own health care,” she said.

“Already a third of New Zealanders have medical insurance. As countries who have been dependent on medical insurance have discovered to their cost, this leaves the most vulnerable section of the community without cover. This is the section that has the greatest need for medical care, yet under a user pays system, they will receive even less than they do today. “Twenty-five countries now have lower pre-school death rates than we do. In almost all child ■

statistics, countries like Sweden are ahead of us. It is no accident that those countries which integrate their health services and work for equal access to services have better results than ours,” she said.

Mrs Nuthall emphasised that child health reflects environmental factors.

“The poor have more illness. Behavioural, educational and social maladjustment are more common than when the income is higher. 11l health, both mental and physical, is exaggerated by large family size and unemployment. “Though the statistics I have quoted refer to children, the same is basically true for adults. For instance, unemployment is associated with more depression, more suicides, more drug and alcohol problems, and so on. Today, 40 per cent of the problems presented to general practitioners have no diagnostically organic base,”. Mrs Nuthall said.

“Each year we discover more links between the physical and emotional — like those between heart attacks and stress, between tension and pain. So, if your circumstances are bad, ill health often follows.”

The present no-growth period for health budgets meant that priorities must be set.

“We are going to have to choose between two principles — excellent care for few, or a general improvement in the care of many. “Most people remain at home while receiving medi-

cal care. Only one in 10 elderly New Zealanders live in institutions. Yet we spend nearly 80 per cent of the health budget on hospitals. Fifty per cent of the total health budget is spent on people in the last year of their lives,” she said, “Lifestyle diseases are preventable, but money is not being allocated for their prevention. We go on expanding expensive hospital services to treat people with preventable diseases. At the same time, we are spending enormous amounts on expensive treatments which extend life only for a few weeks or months, or perhaps a few years.” Mrs Nuthall was particularly critical of the small amount spent on health education — “only 0.07 per cent of the health budget.”

“We spend 27 cents a person on health education a year, compared with $361 a person for other health services. There are now five health educators in New Zealand. Do you wonder they hardly make an impact!” Mrs Nuthall pointed to the vacant position for a community dietitian in the Christchurch office of the Health Department; funding difficulties for the diabetes service; and inaction by Government to curb smoking rates. “Should we spend more money on heart units, or forgo even one bypass operation in order to educate people about salt? Should we continue to operate omas many people with canceijtof the throat as a

result of smoking, or spend the equivalent of a few operations on education against smoking? Should we reconsider giving life-saving treatment for a few of the elderly in favour of creating more day care programmes for many more elderly people?” Mrs Nuthall is a social worker with a private medical centre in Christchurch, and took part in a pilot scheme to demonstrate that there was a place for trained counsellors in private medical schemes. A former Canterbury University Council member, she has been a member of the Social Workers’ Association executive for some time, and is secretary of the association’s Education Training Committee. She is a mother and wife, and has been a medical social worker since 1969. She concluded her address to the annual meeting by calling on thinking citizens to evaluate new health policies as to whether they would affect all New Zealanders equally, or whether they would divert resources away from those with the greatest need.