Chris Hipkins, New Zealand Prime Minister 2023

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#3092420 20-Jun-2023 10:54

ockel:

Its incredibly close to the NHS system in terms of inefficiencies. It should be more like Australia with Medicare with a similar economic structure (2% levy thats ringfenced from political spending) and rebates for private insurance.

The Medicare Levy is not ringfenced, because the Australian Constitution requires that all federal taxes be allocated to Consolidated Revenue. And both the private and public health systems have the same problems as New Zealand does - I just got a referral to a specialist, and calling the practice they informed me there is an eight month wait, or "only" four months if I was already seeing them. Ramping times at public hospitals are up to four hours - that's without seeing a triage nurse, and the paramedics unable to get back on the road because they can't hand over. And don't get me started on private health, which is a highest order rort that people only get because the government blackmails them with extra tax if they don't. I don't understand why you hold it up as some sort of aspirational goal.

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GV27

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#3092449 20-Jun-2023 11:31

ockel:

Simply put its another beat-up on business akin to the supermarkets (who are less profitable in NZ than their Australian counterparts on an EBIT margin or ROIC level)

Quite something too, that the retail banks get a market study thrown at them in an election year while RBNZ was allowed mark its own homework for the Covid response, and there seems to be no ongoing consequences for missing their own revised forecasts and letting the FLP continue to run even as house prices were scorching away.

If you want to take a look at the banking landscape of this country, the RBNZ (and the bloke you reappointed for another term on a higher salary) is probably the place I'd start - given that financial stability in the financial system is literally the reason they exist.

ockel

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#3092452 20-Jun-2023 11:37

Kyanar:

The Medicare Levy is not ringfenced, because the Australian Constitution requires that all federal taxes be allocated to Consolidated Revenue. And both the private and public health systems have the same problems as New Zealand does - I just got a referral to a specialist, and calling the practice they informed me there is an eight month wait, or "only" four months if I was already seeing them. Ramping times at public hospitals are up to four hours - that's without seeing a triage nurse, and the paramedics unable to get back on the road because they can't hand over. And don't get me started on private health, which is a highest order rort that people only get because the government blackmails them with extra tax if they don't. I don't understand why you hold it up as some sort of aspirational goal.

Appreciate your thoughts. The grass is greener from where we sit. Its a spectrum of models from the UK's NHS to the US employer funded full private model (with unattractive acute care). Neither is particularly attractive - NZ sits towards the UK, Australia middle-ground between the two extremes.

So it begs the question - who has the aspirational model for healthcare? Who is best practice (or has elements of best practice to pick from)?

Sixth Labour Government - "Vision without Execution is just Hallucination"

ockel

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#3092454 20-Jun-2023 11:42

GV27:

ockel:

Simply put its another beat-up on business akin to the supermarkets (who are less profitable in NZ than their Australian counterparts on an EBIT margin or ROIC level)

Quite something too, that the retail banks get a market study thrown at them in an election year while RBNZ was allowed mark its own homework for the Covid response, and there seems to be no ongoing consequences for missing their own revised forecasts and letting the FLP continue to run even as house prices were scorching away.

If you want to take a look at the banking landscape of this country, the RBNZ (and the bloke you reappointed for another term on a higher salary) is probably the place I'd start - given that financial stability in the financial system is literally the reason they exist.

Its not like the banks have suddenly increased their earnings over the last 5 years. But one couldnt call for an market study in the past - it needs to straddle an election to be seen to be doing something. Add it the weighty tomes for petrol stations and supermarkets - an endless supply of toilet paper quality research.

Sixth Labour Government - "Vision without Execution is just Hallucination"

sen8or

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#3092465 20-Jun-2023 12:10

The study will say exactly whatever the Govt want it to say, thats just the way they work - frame the questions in such a way as to deliver the response that favours your position. They will also be able to milk the inquiry for all its worth, "look at what we are doing" sort of thing.

If by some absolute miracle, the study doesn't come back with quite the right words, it'll be so far down the track that it simply won't be mentioned ever again and be buried in "consultancy fees"......

Kyanar

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#3092476 20-Jun-2023 12:50

ockel:

Appreciate your thoughts. The grass is greener from where we sit. Its a spectrum of models from the UK's NHS to the US employer funded full private model (with unattractive acute care). Neither is particularly attractive - NZ sits towards the UK, Australia middle-ground between the two extremes.

So it begs the question - who has the aspirational model for healthcare? Who is best practice (or has elements of best practice to pick from)?

A large problem is primary care funding. I imagine this is the same in New Zealand, but here a lot of people go straight to the emergency department for relatively minor ailments because it's simply too expensive to see a GP. Medicare has been eroded so far that the percentage of doctors who bulk bill (don't charge out of pocket fees to the patient, with the government making the entire payment) at record lows. I have to drive to the other side of the city to see my closest bulk billing doctor, and some cities such as Hobart don't have any at all, meaning 15 minutes with your GP is a $75 upfront payment that people simply can't afford - so straight to the overworked public hospital it is.

Funnily enough, there has been talk of changing primary care funding to be more similar to the NHS' outcome focused model, rather than the current presentation focused model.

ockel

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#3092493 20-Jun-2023 13:47

Kyanar:

A large problem is primary care funding. I imagine this is the same in New Zealand, but here a lot of people go straight to the emergency department for relatively minor ailments because it's simply too expensive to see a GP. Medicare has been eroded so far that the percentage of doctors who bulk bill (don't charge out of pocket fees to the patient, with the government making the entire payment) at record lows. I have to drive to the other side of the city to see my closest bulk billing doctor, and some cities such as Hobart don't have any at all, meaning 15 minutes with your GP is a $75 upfront payment that people simply can't afford - so straight to the overworked public hospital it is.

Funnily enough, there has been talk of changing primary care funding to be more similar to the NHS' outcome focused model, rather than the current presentation focused model.

It is very similar in NZ. Most primary care runs on a capitation model - a fixed sum for each enrolled patient (regardless of whether that patient present zero or 100 times in a year). Many GP's charge a co-pay on top of it (although under 16's(?) are free). Its been under review for some time with no real indication of when or if it'll change. Primary care gets about 5% of the total (or ~$1.1bn) healthcare spend. Patient growth is running about 6% pa but funding isnt growing as fast as that. Many practices have closed their lists which makes it more difficult.

After-hours care are more like acute ED's in the US. Always a payment for care. So patients that cant afford do turn up at hospital. On some occasions the hospitals will hand out after-care vouchers to divert the walking unwell (who should see a GP but cant/wont due to cost/work etc) to an acute clinic.

It doesnt help that the hospital and primary care funding are very different pathways - and not about the patient. Covid was a classic case of the hospitals taking control of the process in a region and primary care was very late to the party (and IIRC some promised funding didnt eventuate for vaccinations) in terms of being involved in the vaccination process despite generally having the relationship (and medical history) with their patients.

Sixth Labour Government - "Vision without Execution is just Hallucination"

Bluntj

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#3092607 20-Jun-2023 14:54

Australians have better access to expensive pharmaceuticals which is an important factor these days with success of some that we dont have access to. I believe NZ is behind most OECD countries in this respect.

ockel

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#3092614 20-Jun-2023 15:15

Bluntj:

Australians have better access to expensive pharmaceuticals which is an important factor these days with success of some that we dont have access to. I believe NZ is behind most OECD countries in this respect.

True but the PBS is about AUD$15bn or almost 3x per person spend compared to Pharmac.

And the co-pay per script is AUD30 (AUD7.30 for concession card holders - hey theres an idea, notice its not free for some strange reason) with a cap of $1500/yr for most people (50 items) and $260/yr for concession holders (35 items). Compare that to $5/item capped at $100 for NZ.

Sixth Labour Government - "Vision without Execution is just Hallucination"

Kyanar

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#3092632 20-Jun-2023 15:39

ockel:

True but the PBS is about AUD$15bn or almost 3x per person spend compared to Pharmac.

And the co-pay per script is AUD30 (AUD7.30 for concession card holders - hey theres an idea, notice its not free for some strange reason) with a cap of $1500/yr for most people (50 items) and $260/yr for concession holders (35 items). Compare that to $5/item capped at $100 for NZ.

I should note that is the maximum co-payment. Many drugs only set you back about $9. And the PBS is now permitting 60 days supply to be dispensed at a time (at the prescribing physician's discretion) for some scripts which I believe is something New Zealand has done for a considerable time - the flip side being that less people will be able to hit the safety net threshold.

And for what it's worth, $30 is a lot of money to low income individuals and families faced with a choice between picking up their prescriptions or paying their rent.

Bluntj

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#3092727 20-Jun-2023 17:26

Kyanar:

ockel:

True but the PBS is about AUD$15bn or almost 3x per person spend compared to Pharmac.

And the co-pay per script is AUD30 (AUD7.30 for concession card holders - hey theres an idea, notice its not free for some strange reason) with a cap of $1500/yr for most people (50 items) and $260/yr for concession holders (35 items). Compare that to $5/item capped at $100 for NZ.

I should note that is the maximum co-payment. Many drugs only set you back about $9. And the PBS is now permitting 60 days supply to be dispensed at a time (at the prescribing physician's discretion) for some scripts which I believe is something New Zealand has done for a considerable time - the flip side being that less people will be able to hit the safety net threshold.

And for what it's worth, $30 is a lot of money to low income individuals and families faced with a choice between picking up their prescriptions or paying their rent.

Most low income New Zealanders have had free scripts for some time by getting them filled at Countdown or Chemist Warehouse. The largest beneficiary of this latest policy will be the small chemist shop.

GV27

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#3092826 21-Jun-2023 05:55

Bluntj:

Australians have better access to expensive pharmaceuticals which is an important factor these days with success of some that we dont have access to. I believe NZ is behind most OECD countries in this respect.

You could triple Pharmac's budget overnight (and I suspect you would not find a lot of opposition to doing so from everyday Kiwis either) but as a decision-making body they have a lot of work to do and there have been some questions around the time frames it takes for them to make decisions and the process by which they announce them.

https://thespinoff.co.nz/politics/06-12-2022/why-is-pharmac-playing-petty-media-games-with-life-saving-news

This is the one agency where this sort of thing should absolutely not be tolerated - not getting runs on the board means people dying. It passed without a resignation or any further note. It simply cannot be allowed to fall foul of the same malaise affecting other state institutions, yet here we are.