A physician’s memoir describing a successful research program leads to pondering about research funding strategies. A few years back, I was, in effect, commissioned to review the development possibilities of a local biotech industry, especially one for creating new pharmaceuticals. At the time, it was fashionable in every regional plan – anywhere in the world…
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What can you do when you have hit your borrowing limit and still want to spend? One option is to cut back on maintenance of your capital – say, to delay repainting the house or keeping the car in tip-top condition. The government does the same. Hence our three water systems leaking, polluting and flooding;…
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Published by AHAA (Apologies for the tabulation presentations.) Introduction By way of background, doing some unrelated work I came across some international data on the healthcare sector which seemed to contradict my, and the conventional wisdom’s, view of the healthcare sector. Broadly, it is that the sector has been underfunded. That is not what the…
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By international standards the New Zealand healthcare system appears satisfactory – certainly no worse generally than average. Yet it is undergoing another redisorganisation. While doing some unrelated work, I came across some international data on the healthcare sector which seemed to contradict my – and the conventional wisdom’s – view of the healthcare sector. Broadly,…
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This was a note I prepared for myself International experience provides very little guidance to the problem of designing an effective health system; there is little structural convergence between the health systems of affluent countries on the supply-side. One almost universal exception to this pessimistic conclusion is that the funding of a health system needs…
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Healthcare sector management needs to break away from its obsession with financial information and focus on funding for access. Health New Zealand recently ‘proactively released’ 454 pages about its financial performance to July 2024. Here is a letter it did not release. Hon Dr Shane Reti, Minister of Health. Dear Minister. We have been deluging…
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Comment to Fabian Society at the National Theatre Alive Film of ‘NYE’: 13 September, 2024 You will hear I have some voice limitations. It is the result of successful surgery on my larynx. When I reflect on what happened, I am struck at the quality and the expertise of the healthcare professionals who treated me…
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The claim that there are currently 14 layers of management at Health New Zealand, raises wider issues of how we organise systems. I want to write a column about current proposals to redisorganise Health New Zealand but, frustratingly, the Coalition Government has not released evidence of its claim that the successor to the District Health…
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If you don’t understand how things work you make foolish mistakes. To explain how the government got into its cancer drugs muddle, we need to explain first how New Zealand’s pharmaceutical purchasing system works. There is a parallel between Pharmac and the Reserve Bank of New Zealand. The Government sets the monetary policy framework with…
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The Government says it will give localities more control over healthcare decisions. But how? New Zealand’s political reflex is that any problem can be resolved by further centralisation. Students will be officially banned from having cell phones at school from Term 2. The decision could have been left to individual schools. Each knows a lot…
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Public policy towards tobacco consumption remains politically sensitive. In 1983, a young researcher was told by a medium-level Treasury official that Treasury policy was to abandon excise duties on tobacco. The senior Treasury economist that I consulted, famed for his commonsense, snorted ‘we need the money’. He explained that no-excise-duty was the ambition of a…
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Note written for circulation January 2024 In 2023 the New Zealand Health System was further centralised. As usual, the reasons given for the redisorganisation were unclear, thin and unconvincing. There have been no immediate benefits evident from the new structure; experience suggests that if there are any, they will take time to manifest themselves. Downsides…
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Did you think the incoming government promised to extend bowel screening to 50-59 year olds? The promise was more limited – and more feasible. National’s Manifesto promised: Bowel cancer is the second highest cause of cancer death in New Zealand, while we have one of the highest rates of bowel cancer in the world. More…
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This is an exploratory study and may be of little value. By way of background, I observed a Kings Fund study which ranked the British health system with a group of other affluent OECD countries. I thought it would be interesting to do this for New Zealand. I got deviated when I found an…
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Kaitiaki Nursing New Zealand May 25, 2022 It was surprising that Finance Minister Grant Robertson, in a pre-Budget speech, said that he thought the current health system was “incredibly inefficient”. Of course there are some inefficiencies in health-care delivery, just as there are in private enterprise: mistakes happen, some treatments could have been managed better…
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Prologue This arises from an invitation by Head and Neck Cancer Support Aotearoa to set down my recent experiences. A writer always asks, who am I writing for? It would be pointless to write for those who have already had treatment; most will have had far more rugged experiences than I had. So I am…
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Presentation to the 2021 Conference of Theatre Managers & Educators, Dunedin 5-7 May. Today I am going to discuss the governments plans for the health system. Let me begin with an admission about my perspective. Many New Zealanders are more centralist in their view of the governance of society than I am. I come from…
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Presentation to the 2021 Conference of Theatre Managers & Educators, Dunedin 5-7 May. A few weeks ago, the government announced the next health sector redisorganisation. So I have scrapped the presentations I promised, in favour of an account of what is happening and where we might be going. Today’s presentation is centred on a history…
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Centralising the Public Health System The proposed health redisorganisation seeks to markedly centralise the health system. Is this grab for power justified; will it work? The Cabinet paper’s justification of the proposed changes is sevenfold. The first two are about Maori issues. One is constitutional, arguing that the ‘public health system does not meet the…
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I have been gripped by the World Oddometer’s daily reports tracking the covid statistics. In a way it was a rejection of Stalin’s ‘one death is a tragedy; a million is a statistic’; I have watched with agony the paths of various countries. But this statistician knew that the data reflected reported deaths from covid,…
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