Public versus private health

Apparently, in Aotearoa New Zealand, we have the lowest numbers of specialists per capita in the OECD (Ashton et al., 2013). That is not a great statistic for any nation to have. And it must make the pressure on healthcare more severe here than in most other nations.

I am a member of Southern Cross, a private healthcare provider/insurer. Southern Cross is a trust, run on a co-operative structure - and I thoroughly appreciate their service. I just wish that there was less of a need for it, though. For example, my mother recently needed cataract surgery, and was able to have both eyes operated on immediately. Yet those without insurance (and who cannot afford to pay the private medical surgery costs themselves) must wait on public lists for months: and needing to meet severity tests to be allowed access to a specialist appointment. and that only gets them a place on their local hospital's surgical list... where, after waiting perhaps 9 months or a year to reach the top of this list, they have a single eye operated upon. Then they go down to the bottom of the list to have the second eye done. Yet, because they can see from one eye, their need is less urgent; so they may no longer meet the criteria for surgery.

We appear to have two tiers of access to 'normal' health services: those who can pay - and get the 'cream'; versus those who cannot - and get the dregs. I am not talking about emergency care or life-threatening treatments: that care is pretty equitable. I am talking about those services which make our lives worth living. Like being able to see. Like getting a hip replaced before the pain reduces our quality of life. Like having tendon grafts. This type of health care access inequity offends my sense of fairness.

Medical services are expensive, and requirements are increasingly complex, yet the Nordic nations manage to run sound healthcare systems (Knudsen et al., 2019; Nordic Health and Welfare Statistics, 2024) possibly because they levy higher levels of taxation (OCED, 2018). I wonder if we have reduced so much taxation from our New Zealand system that we no longer have the wherewithal to pay for the services a democratic society might naturally expect to have...?

Additionally, I have been thinking about the gap between the public healthcare system and the private one. We have a couple of friends who are ophthalmologists. They improve their income by splitting their practice between private and public. While both are committed to the public system, it is the private system which provides their retirement funds and a less frenetic pace of practice.

But. The private sector adds pressure to public services: the private sector externalises emergency care and risk onto the public healthcare system (Penno et al., 2021). I don't know how we get around that fairly... or even if we need to try to change that when we are also so short of specialists (Ashton et al., 2013). But if we are going to have private healthcare, we also appear to need a good public system, as the public ambulance at the bottom of the private cliff.

The trouble is, none of this is simple to fix. The levers are multiple; and where inexpert, short-termist policy can generate significant consequences for those on the margins of our societies. There are no easy answers in this sector, but I do wish our governments would take a cross-party, long-term strategy in investing in the health of the nation. 

Sam

References:

Ashton, T., Brown, P., Sopina, E., Cameron, L., Tenbensel, T., & Windsor, J. (2013). Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors. The New Zealand Medical Journal, 126(1383), 1-11. https://nzmj.org.nz/media/pages/journal/vol-126-no-1383/sources-of-satisfaction-and-dissatisfaction-among-specialists-within-the-public-and-private-health-sectors/4e5b26130a-1696475225/sources-of-satisfaction-and-dissatisfaction-among-specialists-within-the-public-and-private-health-sectors.pdf

Knudsen, A. K., Allebeck, P., Tollånes, M. C., Skogen, J. C., Iburg, K. M., McGrath, J. J., ... & Øverland, S. (2019). Life expectancy and disease burden in the Nordic countries: results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. The Lancet Public Health, 4(12), e658-e669. https://doi.org/10.1016/S2468-2667(19)30224-5

Nordic Health and Welfare Statistics. (2024). Health Statistics for Nordic Countries. https://nhwstat.org/publications/health-statistics-nordic-countries

OECD. (2018). Chapter 4: Country tables, 1990-2016. In Revenue Statistics 2018 [report]. Organisation for Economic Development and Co-operation. https://www.oecd-ilibrary.org/docserver/rev_stats-2018-7-en.pdf?expires=1722380271&id=id&accname=guest&checksum=6FE2F3689A9ECC11E9184A273A7965B1

Penno, E., Sullivan, T., Barson, D., & Gauld, R. (2021). Private choices, public costs: Evaluating cost-shifting between private and public health sectors in New Zealand. Health Policy, 125(3), 406-414. https://doi.org/10.1016/j.healthpol.2020.12.008