WHAT PRICE DINNER?

SARAH DALTON, EXECUTIVE DIRECTOR

When the price of groceries goes up, is it fair to label shoppers who can no longer afford them as being ‘financially illiterate’?

The reality is prices are going up everywhere and the health care system is not immune to rising cost pressures.

The newly appointed Commissioner of Te Whatu Ora, Professor Lester Levy, has suggested that the now-removed board members were not across Te Whatu Ora’s finances.

This has sparked a debate about whether the board was irresponsibly overspending, or if the health system as a whole is underfunded. Our research shows it is the latter.

Politicians argue this is not the case. They use words like ‘record investment’ in health, but closer analysis shows this year’s real increase to health spending –the spending that will benefit frontline patients – is only $93 million, or about 0.4 per cent of Vote Health.

If you buy 0.4 per cent more groceries, would you say you had a ‘record breaking’ shop?

Professor Levy has been tasked with cutting $1.4 billion from the never-ending grocery bill of the health system. He has claimed he can do this without affecting frontline staff.

I say that is impossible. Taking our grocery example (likely too far, but bear with me), if the frontline product was a meal, what can you realistically cut from that bill that will have no effect on the front line?

You can cut the portion size, purchase lower quality ingredients, change the type of meal you serve, but all of these changes will have some tangible, detrimental effect on the end product.

You will still serve a meal, but it will be smaller and less nutritious. You’ll most likely still be hungry afterwards.

Professor Levy’s claim that 2,500 jobs from ‘management bloat’ can be cut without any impact on frontline services is unrealistic.

Are we saying these 2,500 people did nothing during their workday? None of them coordinated clinical rosters, none of them managed cleaning of emergency departments? Can we say none of them ordered clinical equipment, curated needs of clinical wards, helped organise patients, provided after-support to patients or did anything that could not be connected to the front line?

Efficiency is always a goal, but hospitals do not run on profits, nor should they. Health will always carry a cost of provision. Politicians get too caught up in numbers and bottom lines –often to fund tax cuts – to realise that the health care system is about, you guessed it, health and care.

The answer to the health care crisis is more money, not less spending. It is not financial illiteracy to point this out. This is not a popular political opinion, regardless of what political camp you are in. Political parties have long taken credit for any health care gain and blamed any negative aspect on the ‘previous government’.

Our see-sawing political system means there is little ‘continuity of care’, and this is why ASMS has released a paper in the New Zealand Medical Journal calling for an independent review of health care funding.

Politics tends to deliver answers such as targets and spending cuts, and lacks the long, long view. We need health decisions to be measured across decades, not political cycles.

An independent inquiry could look at the system, see the increasing demand for acute care – well outside the rising population numbers – see the growing wait times, and conclude that people are living longer with more complex medical needs.

It will also see the health care system is already scrimping and saving – doing as much as it can with the limited resources available.

New Zealand’s investment in the health system tends to be lower than comparable countries and its productivity relatively higher. In 2021, New Zealand’s total public and private health expenditure was 10 per cent of its gross domestic product, compared to an average of 11.7 per cent for 14 comparable OECD countries.

An independent inquiry could see that in order for New Zealand to match this spend it needed to invest another $5.8 billion, not cut $1.4 billion.

We need the inquiry to take a good, honest look at our health care grocery bill.

The alternative is that New Zealand will have to decide what dishes to cut from our menu or, the worst-case scenario, let our people know they cannot come to dinner.