THE PRESS WEDNESDAY, JULY 19, 1989. Setting health priorities

Press, 19 July 1989, Page 18

THE PRESS WEDNESDAY, JULY 19, 1989. Setting health priorities

The Canterbury Area Health Board, required by the Government to cut its spending by about $3O million by next June, is on course for an inevitable collision with public opinion. The board has before it a range of choices compiled by • its own special committee on cost-cutting; not all will be needed to meet the Government’s requirement, so the board has some latitude. The public has less than three weeks to help the board sort out which are the least objectionable measures before the board begins making the hard decisions on August 16. Nothing is more certain than that each of the proposals will stir considerable opposition and genuine concern from the community. To get close to the level of savings demanded of it, the board must consider such extreme measures as closing four major and seven country hospitals, and cutting health staff by up to 600. The special committee of 13 set up by the board comprised officers of the board, senior health professionals, and representatives of the health unions. It has done what can be deemed to be a careful audit of efficiencies in the board’s operations, to the point of scraping together $250,000 by trimming "fat” from pathology services. Obviously the board must do more than pare a few thousand dollars here and there. Even these relatively small reductions might upset a few people. All added up they would not produce the tens of millions of dollars that the Government demands. The result is a list of options that are conspicuous for chopping away large lumps of the health services in Canterbury. Strong arguments can be raised against each possible cut that the board contemplates. Some in particular, such as the proposal to close Christchurch Women’s Hospital, seem. ill-advised and certain to arouse maximum controversy. Even so, the board cannot accept all of the good arguments it is likely to get. Doing nothing is not an option. Like all of the country’s health authorities that are trying to allocate money between one hospital service and another, the board has an almost impossible job. Area health boards are trying to cater to a demand for health services that never can be fully satisfied and they have to meet the costs of the very expensive technologies needed to remedy ills that a few years ago were untreatable. It is probably true that, in a country with an economy as weak as is New Zealand’s, we must limit expectations of modern medical miracles being instantly available; but, human nature being what it is, a common perception is that life-prolonging technology should be available if it is there for the having. The multiple demands on a finite dollar inevitably mean that someone or something misses out. Priorities must be set and these cannot suit everyone. Wherever the board’s eye turns to find the necessary savings, the story is likely to be the same: any cut will be opposed strenuously. Caught between the

need to produce a cost-cutting programme and the heated expression of public opinion, the board is unlikely to find a solution that will satisfy public opinion, Government budgetary demands, and medical needs. The board is no doubt mindful that the most compelling of these factors at present is the Government. If it is dissatisfied with the board’s enthusiasm for cost-cutting, the Government could well implement an Auckland solution and replace the board with an appointed commissioner. The Government has done very well at shifting the onus and odium of this costcutting to the area health boards, all of which are being forced to curtail services beyond a reasonable demand for the best possible efficiency. In the long run, however, the Government' cannot escape the responsibility for the reduction in health services. Until the Government decides to prune its own spending elsewhere to release more money for health services, the Canterbury Area Health Board, like all the others, will be in its present bind. No matter how far the Government seeks to distance itself from local decisions, it is still in charge of the tax purse and ultimately determines just what degree of health service the country will have.

The Prime Minister, Mr Lange, promised the country in the last General Election campaign that a Labour Government would provide the “best health service that money can buy.”

An ambiguous statement then; just what that promise amounts to now is far from ambiguous. If the ambiguity was calculated in 1987, it must now be rated a bad joke. The country’s hospital services spend $6.5 million a day, or a little more than $2 a head for each man, woman, and child. This is not an exorbitant price for a health service if it is up to the job that the community expects of it. If the public is not prepared to accept the possible cuts in health care, the greater expectation implies a readiness to pay for the retained or expanded services that are wanted. The Government cannot escape the message and will have to reconsider whether its spending priorities are the same as the community’s. The questions then become: what sectors of Government spending should be reduced further to allow health spending to continue or increase? If cuts are not acceptable elsewhere, how much more tax are people prepared to pay to maintain health spending? Or is the health dilemma simply an example of the economic and social contradiction that represents New Zealand and which says that the lower Government deficit is something that neither the Government hor public health can afford. Given the outcry against health cuts that go beyond attaining maximum efficiency, the Government should be pressed to resolve the question. The outcry has to be directed to the. right quarter.