Lives and money: The dangerous business of health privatisation
What’s the true cost of privatisation of healthcare in Aotearoa New Zealand? Lives and money – much more money, writes Dr Renee Liang.
Last week, ACT leader David Seymour suggested that people might want to take out their $6000 ‘share’ of per capita health spend from the public pool, and use it to buy private health insurance.
Well. You could almost hear the slaps around the country as doctors facepalmed. Seymour’s suggestion is at best disingenuous, and at worst calculating and immoral. Any move towards a privately-run healthcare system will end up costing us lives, and much much much more money.
As a paediatrician who covers small and large regional hospitals around Aotearoa, I see that our health system needs work. Years of underhanded starvation by successive governments of all stripes have led to inefficiencies, confusion, and inconsistencies in care. I’m 100 per cent with you on the need for something to be done. But privatising isn’t the solution.
Don’t believe the shiny lure – there’s a hook behind the bland simplicity of Seymour’s statement. To believe that $6000 will pay for any significant medical care is naïve. It buys four nights of a hospital stay, without medications, procedures or specialised care. And would a hospital really deny care to someone whose ‘allocation’ is used up? (Yes, look at the US healthcare system.) Know that Seymour’s suggestion is dangerous for you and your family – even if you have the money to pay for insurance now.
Here’s why. Private healthcare here, and in other countries like Australia, sponges off the public system. The premium you pay takes this into account. Sponging? Isn’t that unfair? Haven’t we been told that going private ‘takes the load’ off public? Um, no.
Point #1: Private cannot function without public as back-up. Ever noticed that they’re building private hospitals near to public ones? It’s very sensible as private hospitals don’t have emergency teams on call – if any complications arise, they rely on being able to transfer patients back to the public system. Because of this, private hospitals carefully select their clientele. Got too many chronic illnesses? Sorry, your operation will have to be done in public. (Though maybe we can quietly queue-jump you.) If public hospital scaffolding is dismantled, each private hospital will have to build its own supports – or worse – ignore their responsibility to keep people safe (cue ambulance-chasing lawyers).
Point #2: Multiple international studies have shown that a private healthcare model. based on citizens buying their own health insurance, always ends up costing governments more money for less care and worse overall health outcomes. (Again, consider the US where the fastest way to become poor is to get sick.) Health insurance is big business, and business always needs to make money, duh. The easiest way to deliver profit for shareholders is to restrict options to the cheapest ones, and cut ‘unnecessary’ expenses such as staff and training. You might notice that our current Government is taking inspiration from this model. Add in the extra layer of bureaucracy needed to deny, oops I mean process, claims, plus the marketing and strategy and management layers, and the costs rise even further. Guess who pays these extra costs – patients through their insurance premiums. A friend tells me that $2k per month is normal for health insurance in the US.
Point #3: We have a finite pool of doctors in this country. The same doctors who staff public hospitals also work in private. (Which means that the widespread belief that private healthcare is somehow ‘higher quality’ is also wrong, even if the waiting rooms have more expensive couches). Siphoning off those highly-trained consultants to work in private affects public waiting lists, and most of those doctors would actually prefer to work in public if they were given the resources they needed to work effectively and efficiently. I know that ‘queue jumping’ is commonly discussed in patient forums – for example, if you pay to see a specialist in private you might get prioritised onto their public waitlist. Apart from this being unbelievably unsporting, it also bleeds resources from a public system which has been built on the principles of ‘the greatest good for the greatest number’.
Point #4: As a senior doctor, it’s considered good practice to discuss tricky cases with colleagues, and call experts in other hospitals for advice or help. We move patients to the best unit with available space to achieve the best outcome for that person, for example moving a premature baby to a higher level care or to a unit with sufficient space. We don’t offer differing levels of care to people with differing abilities to pay – being able to offer the best of ourselves, fairly and according to our ethical principles, is one of the ‘perks’ of working in a universal healthcare system (I can’t believe this is even considered to be optional in any healthcare system). In these times of lean staffing, we also don’t hesitate to jump in a car or plane to help out at each other’s hospitals on our days off. I can’t see this kind of support happening easily under the business model of private healthcare, where profit is prioritised over co-operation.
A final plea: I belong to an online chat group of NZ doctors with over 6,500 members. When I asked them for their views on privatisation, every single person who replied, including the ones who work in private, said privatising healthcare is a terrible idea and they were feeling desperate and worried.
Doctors believe in the public healthcare system – after all, along with our other health colleagues, we’ve been propping it up. We believe that everyone has the right to good health and excellent care. We can see where targeted changes – for example IT systems that actually do what they’re designed for, access to more theatre space, specialists being allowed to work to their talents instead of attending meeting after meeting to beg for resources – would give us more time to see you, our patients. We’ve been begging politicians to listen for what seems like forever. Please don’t lose hope. We can make it better together.