One of the problems of being a doctor in New Zealand is being asked to sign documents that are untrue for the benefit of patients or patient’s parents. I wrote to the Minister of Social Development twice after I had a confrontation with a patient’s parent – you can see the letters here >>>. The first letter got ‘lost’. Because the Minister was not willing to do anything, I went to my local MP, Tim MacIndoe, and was advised that I could petition Parliament. I therefore asked my colleagues to sign a petition requesting “that the House of Representatives considers legislative and policy changes (as required) to the administration of the Child Disability Allowance, including a recommendation that the requisite medical certificate be signed by a paediatrician or medical specialist but not by general practitioners, in order to ensure that the policy objectives and guidelines underpinning the benefit are respected and upheld.” A large number of them did.
I thought that the signatures of a large number of doctors who did the assessments would convince the parliamentary select committee that change is needed. Sadly this was not the case. The petition to have the certificate for Child Disability Allowance assessed by an independent specialist was rejected by the Parliamentary Select Committee, on the advice of the Ministry for Social Development.
I believe there is widespread fraud in the issue of the child disability allowance. As a percentage, I believe it is much worse than for sickness benefit. The conclusions of the documents provided by the Ministry of Social Development are at variance of with the evidence provided by them. The committee members, whose duty it is to ensure that government departments act in the public interest do not appear to have analysed the evidence critically. Otherwise they would have come to the conclusion that change is necessary. What follows is an analysis of the evidence. The decision of the Committee can be found here >>>.
The Department’s submission, written by Sue Mackwell (see here >>>) concludes with the sentence, “We believe that the current process meets the policy objectives of CDA and do not recommend any change to it.” Even a cursory examination of the evidence suggests otherwise.
In the background information is written, “total expenditure on CDA in 2009/10 was $102.014 million compared to $97.956 million in 2008/09”. The graph at the end of the “Factsheet – Overview” shows a doubling of numbers over ten years, with a minimal decline recently. The changes in the administration three years ago cannot be said to have made a large impact, and there are other explanations, such as increased doctor resistance to signing a document that is often untruthful.
The Factsheet section “People receiving CDA” lists that 603 received CDA for three children, and 117 received CDA for more than three children. This would appear to be either amazingly bad luck or evidence of abuse of the child disability allowance. One wonders what kind of disabilities these families have. My limited experience is that the children of these families have illnesses but these are mild. There may be one child with moderate asthma or eczema, but when the caregiver learns what valuable additions to the family income are available, all of the other children are added. With four children, the extra family income is $9112 per year.
The Department is able to investigate this situation. When the doctor signs the medical certificate he ticks a box that says the assessment is subject to audit. Has the Department ever investigated, and if not, why?
The table of conditions for which the CDA provides funding is illuminating. I asked a paediatrician how many children with ADD hyperactivity should be on the benefit, and he said ‘none’. One wonders what the alcohol and drug conditions were. One wonders about cleft palate and lip. Before surgery feeding takes longer and there is the prospect of surgery, but after surgery the only disability is cosmetic. Epilepsy with very frequent seizures but this is relatively rare, and most children with epilepsy are well controlled on medicine. They would not qualify as needing “attention and supervision substantially in excess of that normally required by a child of the same age and sex”. The same consideration applies to digestive system disorders, heart conditions, respiratory disorders and skin disorders. Has the Department in giving out this public money ever conducted an audit? If an audit is available, why have the results not been given in the Department’s submission?
The Department provided a “Comparison of the Child Disability Allowance with comparable allowances in other countries including the involvement of health professionals to determine eligibility” – see here >>>. The Department claims that “the assessment process appears to be broadly similar to New Zealand.” The summaries of the various countries that follow show otherwise. The assessment system in the UK and USA are quite different and much closer to what is recommended in the petition. In the UK, “assessments for Disability Living Allowance use existing information that is held about a person’s disability where possible. Where additional information is required a medical examination is conducted by a selected healthcare professional who has completed specialised training. Clients do not get to choose the examiner but can specify the gender.” In the USA, “the assessment for Supplemental Security income includes a review of all information that has been provided to support an application including medical information provided by a doctor.” That is, it is a review based upon records, by someone independent.
Normally, the duty of the doctor is to the patient. They act as a patient advocate. Acting for the taxpayer puts them into a conflict of interest. I have heard doctors ask why Work and Income does not have special training for a group of doctors who would see children for assessment and be paid by the department. I have never heard an answer to this. Yet this is what happens in ACC, Civil Aviation pilot assessments, and Insurance Medicals. This has also been done previously by WINZ, where the GP wrote a host doctor report to an independent doctor for assessment for invalid’s benefit. I have heard it expressed by doctors that they will just sign forms. “WINZ caused the problems, WINZ can fix them”. And I have heard, “I am not paid to have a fight with my patients”. There is also a financial incentive to sign the forms.
In her letter, Sue Mackwell writes, “there is no evidence that specialists or paediatricians are more qualified or ‘better’ at completing the medical forms than GPs. A child’s general practitioner would be in the best position to judge the level of care the child needs.” This misses the point. The general practitioner may know the patient best, but is in the worst position to recommend a government payment because of a conflict of interest.
John Key has promised that if his Ministers don’t perform, he will replace them. He also aims to reform welfare, as the present system will help to bankrupt us. This is a popular message to his constituency. I question whether this is genuine, and he really is interested about doing something rather than just talk.
The solution to the child disability allowance problem is straight-forward. If the government, essentially the National Party, cannot solve this problem, they will never solve the sickness benefit problem, with its many fish-hooks. It is a matter of integrity whether John Key and his party will do what they say.