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1 April
07
Questions
of Governance
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 A
Newman Weekly reader, Martin Visser, recently sent me a copy
of a letter he had written to the Minister of Health on 28
November 2006 about the way his brother was being treated by
the health system. In his letter he stated:
“My
brother Anton Visser who lives at 228 Ormond Road Gisborne,
was diagnosed with prostate cancer in 2003. I have been
informed that in spite of numerous referrals and follow up
phone calls by his GP Anton is still waiting 3 years later to
see a urologist… his prostate cancer, while left untreated
is now in an advanced state with a PSA reading of around
100”.
By
December 5th, Anton had fallen and broken his arm
in two places. Two days later a scan revealed his bones were
riddled with cancer, and by the 12th his PSA level
had risen to 340. On December 26th, Anton died.
Family
and friends are understandably outraged. They believe the way
that the government and the District Health Board failed Anton
is appalling. They would like to see some accountability. At
the very least they ask for honesty – if the government
system cannot cope, then patients should be advised to seek
health care elsewhere instead of leaving them in limbo
thinking that help is just around the corner.
What
is so tragic about Anton’s case is that with medical
evidence showing that early detection of prostate cancer can
save up to 90% of lives, if a national screening programme for
prostate cancer had been in place - similar to the breast
screening programme for women - his cancer would probably have
been detected years earlier and could have been treated. A few
years ago I presented a petition to Parliament calling for a
prostate-screening programme (to view the submission, click
here>>>). While the Select Committee has
not yet reported back on their findings, the Ministry of
Health website states that they “do
not recommend routine screening of men without symptoms for
prostate cancer in New Zealand”.
The
Prostate Cancer Foundation have challenged this advice, since
prostate cancer often show no symptoms at all until it is well
advanced, which is why several countries including the USA and
Germany have routine PSA screening.
At
the very least, a “warrant of fitness” health check for
50-year-old men (a comprehensive check-up being promoted by
men's health groups which would include a prostate cancer PSA
test) should be introduced. That check-up would give GPs an
opportunity to alert their male patients to key medical risks
that they face as they grow older, as well as advising them
on healthy living strategies.
Anton’s
tragic case puts a human face to New Zealand’s health
crisis and raises serious questions about systemic management
failure. His death was preventable – he died because he was
denied access to specialist care. But his death should not be
in vain. It should shame the government into action so that
others do not have to suffer what he did.
Bronwyn
Howell, a lecturer in Corporate Management at Victoria
University and Research Associate for the NZ Institute for the
Study
of Competition and Regulation is this week’s NZ Centre for
Political Debate Guest Commentator. She has serious concerns
about the efficacy of our health system’s governance
arrangements and in an article “Governments, Governance and
Trust: unpacking the fiduciary duties of NZ healthcare
quangos” Bronwyn writes: “The health care governance
systems and processes concerning over 20% of government
expenditure appear to defy most rational principles of sound
governance design. Ultimately, responsibility for this
shortcoming lies at the feet of the politicians who have
established these systems and the ministerial officials who
advise them and carry out the disbursement processes.
Questions need to be asked about what will be done to redress
the problem”. (To read the article click
>>>)
Just
this week the New Zealand Medical Association claimed that
patient care was being compromised by a grave shortage of
trained doctors and specialists in at least three District
Health Boards – Southland, Wanganui and Wellington’s
Capital Coast Health – with the Wanganui Health Board
accused of “never-ending
failure” during a Parliamentary
Select Committee hearing.
Meanwhile, health unions are warning that the health
system will be “bogged down in industrial strife by the
middle of the year”, further compromising the delivery of
critical health care in New Zealand.
But
it isn’t just the health boards and hospitals that are
coming under pressure. In an excellent article “Why the Sick
Will Pay More”, written by Bronwyn Howell for the NZCPD last
year, she warned how Labour’s callous culling of hospital
waiting lists would force the cost of the care of the patients
who had been dumped to pass from the government onto GPs and
their sick patients.
Under
Labour’s new Primary Health Organisation (PHO)
‘capitation’ strategy, doctors in General Practice no
longer receive a fee-for-service from their patients. Instead,
the PHO pays them a fixed fee for each patient on their books,
and they receive a price-regulated ‘top-up’ from patients
who visit. That means that any GP unlucky enough to have large
numbers of very sick patients - who should be in hospital but
have been dumped from the waiting lists – who need frequent
medical care, will be unable to recoup their costs.
In
her article, Bronwyn explained it in this way: “Under the
fee-for-service payment policy, GPs would have been
indifferent to the effects of [the waiting-list cull] policies
as full remuneration would have been received for each
additional visit made, from a combination of government
subsidy and patient payment. Under capitation, however, GPs
must incur the additional costs of providing consultations
that they would not have been required to make, had hospital
treatment been provided, yet they receive no additional
government funding for these additional consultations” (to
read the full article, click
here>>>).
The
cost pressure on doctors in General Practice has been further
exacerbated by the generous pay increases that the government
recently awarded nurses. With wages making up some 70% of the
cost of running a medical practice and pay rises for nurses
amounting to 20% last year and 17% this year (when the costs
of an extra week’s paid holiday is factored in) the cost
escalation in many GP practices is now extreme. It is little
wonder that the number of GPs continues to fall.
Yet
none of this has been recognised by the government, which
contracted LECG Consultancy to set the level of fee increases
deemed to be acceptable under their PHO price-regulation
policy. As one irate GP put it:
"In the 2005/06 year, the LECG Report says a 2.1%
increase in fees is reasonable. Yet General Practice wages
bill increased by 20% not including other practice costs. In
the 2006/07 year, the LECG Report says a 5.3% wage increase is
reasonable, yet general Practices face wage increases of 17%
not including other practice costs. This LECG Report is very
seriously flawed. The data does not in any way represent what
is going on in General Practices around this country!”
Under
the surface of New Zealand’s health system, big trouble is
brewing. The concept of a universal health insurance for every
New Zealand citizen is looking more attractive by the day!
The
poll this week asks: Do you support the concept of a
"warrant of fitness" health check for men? I would also
like to invite anyone with a health horror story they would like to
share to submit the details. Take
part in poll >>>
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