The evolution of medical standards and care in NZ

Forums › Health and fitness › The evolution of medical standards and care in NZ

OldGeek

894 posts

Ultimate Geek

ID Verified

Lifetime subscriber

#311354 9-Jan-2024 12:14

Looking at this article in Newsroom:

Why compassion should be measured as a KPI (newsroom.co.nz)

In particular this comment:

"The problems in modern health care are entrenched and systemic, with roots stretching back to the neoliberal reforms of the 80s and 90s. Covid-19 has compounded matters. How did New Zealand turn one of the world’s premier public health systems into a work environment that is so fraught and stressful that many staff are either circling the drain or going down it?"

Part of this trend - not mentioned - is that this period corresponds to the emergence of very expensive medical technology. We take MRI and CAT scanners for granted now but I remember the times when such things did not exist so I wonder whether part of the problem is that funding medical care is less about human costs and more about non-human costs.

--

OldGeek.

Voyager referral code: https://refer.voyager.nz/6XQR2QG9Q

Stu

Hammered
8336 posts

Uber Geek

Moderator

ID Verified

Trusted

Lifetime subscriber

#3179380 9-Jan-2024 14:33

Moved to Health, for now. Chances are high it'll end up in politics.

People often mistake me for an adult because of my age.

Keep calm, and carry on posting.

Referral Links: Sharesies - Backblaze -

Are you happy with what you get from Geekzone? If so, please consider supporting us by subscribing.

No matter where you go, there you are.

MikeAqua

7779 posts

Uber Geek

#3179392 9-Jan-2024 15:15

I think the main things that have happened are:

Aging of the population
Demand for more expensive medicines and equipment
A tsunami of preventable diseases caused by: Poor living conditions (housing stock, overcrowding, rental/energy costs) and increasing rates of obesity
We have an increasing proportion of Polynesian and South Asian people in the population and those ethnicities are more genetically predisposed to diabetes than Europeans
I'm sure population dietary changes, in particular increases in consumption of processed food, have contributed to the increases in preventable disease as well
I also wouldn't be surprised if people are far less physically active than they used to be.

That's just the physical stuff. Mental health is a whole other kettle of snakes 'n' hate.

Mike

gehenna

8502 posts

Uber Geek

Moderator

Trusted

Lifetime subscriber

#3179447 9-Jan-2024 17:08

Stu: Moved to Health, for now. Chances are high it'll end up in politics.

I thought the same thing this morning 🤣

I don't claim to have any answers, but, I know my own experience in the system with a chronic condition has been hit and miss over the past 30 years since I had my initial diagnosis.

My experience has come down to the individual providing the care. The system behind them is a typical bureaucracy that works well for some and poorly for others. It has worked well and poorly for me at different times during those decades both early and later.

The individuals I have received care from range wildly from complete apathy or incompetence, to wonderfully empathetic and knowledgeable about their domain and how to leverage the system behind them. I had to persist and be stubborn a lot over the years to find the team that I have wrapped around me now. It didn't happen overnight.

I think advocacy helps a lot, whether for yourself or with someone advocating on your behalf. Many are intimated by the health system and others take what they're told as gospel even if it isn't right or doesn't benefit them.

But like most things in a society there are those who are unable to advocate for themselves and don't have anyone to help do it for them, and they fall through the cracks after initial negative experiences.

Having said all that, the fact we are hemorrhaging expertise to other countries because our national health sector can't provide working conditions that don't break them, is unacceptable.

Hammerer

2476 posts

Uber Geek

Lifetime subscriber

#3179477 9-Jan-2024 19:33

A fundamental issue with our medical/health system is that most inputs increase prices faster than the general rate of inflation: medical staff, pharmaceuticals, and medical equipment are obvious examples. This cost pressure means that our system is likely to become less effective unless we spend enough money on it. We aren’t.

Then we add in all the other issues such as competing with Australia for medical staff, the cost of buildings also increasing faster than the CPI, our low rate of productivity improvements, and the increasing rate of lifestyle diseases.

I’d like to see our system restructured along different lines but we can’t agree on what to do and we don’t have much capacity for implementing effective improvements.

frankv

5680 posts

Uber Geek

Lifetime subscriber

#3179567 10-Jan-2024 11:10

OldGeek:

Part of this trend - not mentioned - is that this period corresponds to the emergence of very expensive medical technology. We take MRI and CAT scanners for granted now but I remember the times when such things did not exist so I wonder whether part of the problem is that funding medical care is less about human costs and more about non-human costs.

Medicine, especially public medicine, has always been about balancing funding against treatment. However, in recent years there's certainly been a plethora of new expensive machines that go 'beep' to choose from. And many of the machines (e.g. MRI & CAT scanners), although expensive, are so valuable in terms of patient outcomes that they've become essential equipment.

frankv

5680 posts

Uber Geek

Lifetime subscriber

#3179576 10-Jan-2024 11:49

Health is an area like national security where underspending is dangerous because if it goes wrong the outcomes can be so bad. Which in turn makes it a rich vein for capitalists to mine. So, for example, Patient Administration Systems are a big-ticket item for hospitals. They're vastly more expensive than the booking system for a hotel (although not vastly different), for example, and once a hospital has bought one for millions of dollars they're typically locked into it for decades with millions of dollars in maintenance fees and updates and upgrades each year.

Likewise Clinical Information Systems (providing access to patient clinical records and lab results and imaging). And there's been a lot of spending in NZ on making clinical information more widely available, firstly within each DHB, then across regions, and I guess now nationally. The same applies at different tiers of the system, from primary health at GPs and PHOs to hospitals & DHBs. This has been compounded by the multiple different imaging, lab, and clinical information systems at each DHB & GP & PHO following the neoliberal changes in the 80s and 90s.

Is it better to spend $1M on

a new CAT scanner
or on sharing data so that a patient gets the right treatment if they turn up at ED at some other hospital
or on installing Ethernet or Wifi around the hospital
or updating 1,000 PCs
or hiring an extra surgeon and the nursing staff and junior doctors to support them
or (part of) a new building
or a $2,000 pay rise for each staff member?

Loismustdye

927 posts

Ultimate Geek

Trusted

#3180161 10-Jan-2024 18:40

Having said all that, the fact we are hemorrhaging expertise to other countries because our national health sector can't provide working conditions that don't break them, is unacceptable.

The answer here is to pay a competitive wage to retain the current staff and attract new ones (through training or recruitment overseas). Conditions can only improve when the staffing is sufficient to allow for “better” conditions, and to maintain or increase numbers we need to pay more for their services, especially to compare with our neighbours over the ditch.

The problem is no one wants to actually do this, whether it’s the public paying the taxes or whoever holds the purse strings.

I’ve seen young colleagues go overseas recently with 2 years experience under their belts to immediately jump to a higher salary than those of us in leadership positions are on, along with better conditions and terms, our service has lost senior Doctors to Australia for close to double what they were earning here (and when those Aussie dollars are converted to NZ Monopoly money the difference is even greater).

The argument for the NZ lifestyle doesn’t hold up anymore, and as a country we need to either stump up the $$ for services and staff or acknowledge that we cannot compete and we will try as best we can with what we are prepared to pay for it.

Sharesies kids

Free kids accounts - trade shares and funds (NZ, US) with Sharesies (affiliate link).

MikeAqua

7779 posts

Uber Geek

#3181151 12-Jan-2024 13:56

frankv:

plethora of new expensive machines that go 'beep' to choose from

In 2017 I had a significant surgery and the plethora of things you wake up attached to is impressive and no doubt very expensive. The one I didn't expect, was these legging things that look like cricket pads for astronauts (according to my morphine-addled recollections). They inflate and deflate at regular intervals. Intended to reduce the incidence of blood clots (I think).

Mike

cddt

1553 posts

Uber Geek

#3181154 12-Jan-2024 14:09

Loismustdye:

The answer here is to pay a competitive wage to retain the current staff and attract new ones (through training or recruitment overseas).

When it comes to training new staff it is less about pay and more about the number of available places in medical schools.

ezbee

2405 posts

Uber Geek

#3181168 12-Jan-2024 15:17

Training capacity is a problem if you don't fund it.

Your ability to train erodes with increasing costs and inflation.
The need to upgrade equipment as well, as no point 'just' training people on stuff from 1920's.

Your economists will point out the high costs of teaching staff.
Economists will point out the waste in spending on extra staff that can be mentored to replace those that age and retire.
The inefficency in spending for steady expansion as population grows.

So you get a confluence of your medical staff aging and moving to retirement.
Teaching staff probably are too.
You need more for growth in population, and growth in retirements.

You lose capability to train and now you are in a real bind.

You can pretty much re run this for any trade, school teachers or qualification at the moment.
We may soon be running an experiment to create a knowledge economy without mathematics and science teachers too.

FineWine

2981 posts

Uber Geek

Trusted

Nurse (R)

Lifetime subscriber

#3181250 12-Jan-2024 17:17

I agree with most of the above points. Having worked as a paediatric nurse for 30 years in both Australia and NZ, the NZ model of providing health care is not as good as it is in Australia. Mainly due to the cost of providing a top flight health system.

Part way answer for NZ is to do what Australia did in the 1984 - MEDICARE !

Tax = Medicare levy is 2% of your taxable income by all Australians .

Then there is the Medicare Levy Surcharge which is only paid by those who are single and earning $93,000 or more, or by families and couples with a collective income of over $186,000. The family threshold increases by $1500 for each child after your first one.

If you have private health insurance then you can apply for various rebates.

As the levy does not cover; ambulance, dental, glasses, contact lenses and hearing aids, therefore insurance companies brought out basic policies to cover for these things. For us whilst we lived there, that meant our Medicare levy was 1.5% of our income, a 0.5% discount as we had a basic health care policy.

My partner and I have always said, since returning home in 2014, that NZ must introduce a similar scheme.

Whilst the difficult we can do immediately, the impossible takes a bit longer. However, miracles you will have to wait for.

Loismustdye

927 posts

Ultimate Geek

Trusted

#3181252 12-Jan-2024 17:27

cddt:

Loismustdye:

The answer here is to pay a competitive wage to retain the current staff and attract new ones (through training or recruitment overseas).

When it comes to training new staff it is less about pay and more about the number of available places in medical schools.

The number of placements is schools is often dependent upon the number of placements available within the workforce for the practical component of the training, I’m talking Allied health and nursing. You can’t take on 100 students when to be able to acquire the practical skills to a reasonable (and required) level there is only space in the workplaces around the country for 40.

If the pay and conditions were such that the workforce was larger then there could be larger number of training spaces. It can’t be expected for clinical staff to deliver timely and efficient health services whilst simultaneously being expected to teach increasingly larger numbers of students in the workplace.