Category Archives: Health

Money for Jams: the Government Response to Roading Reforms Is Commercialisation.

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Listener 31 January, 1998.

Keywords: Governance; Health;

The proposed roading reforms are a typical case of the identification of a problem – road congestion in Auckland and Wellington – and a policy solution which has nothing to do with the problem, but forces the sector to conform to “THE MODEL” of commercialising everything. Its report is obscured and confused: it even gives two different months for when it was published. We might predict the outcome if the policy goes ahead.

Out Of Tune: Even the Officials Admit the Health Reforms Were Fatally Flawed.

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Listener 27 December, 1997.

Keywords: Governance; Health;

In a paper to the Association of Salaried Medical Staff, the chairman of the Transitional Health Authority (THA), Graham Scott, reported that the 1991 health reforms were predicated upon productivity gains in the public hospital sector, and that they not occurred. As a result the CHEs are in permanent financial deficit. In Scott’s convoluted presentation – after all he was a past Secretary of the Treasury where the English language is a challenge – “the current deficits in CHEs are not only about inefficiencies and variations in the quality of management but are also an outgrowth of the original efficient pricing policy [whatever that means]. In other words a share of these deficits was made in Wellington, because the policy did not work out as intended. They were in inherent in the policy framework that assumed efficiency gains would be allocated to the deficit.” More simply, the policy failed.

The Efficacy Of the Market

This entry was posted in Health, Regulation & Taxation on by .

Extract from Chapter 2, The Commercialisation of New Zealand.

Keywords: Health; Regulation & Taxation;

This is not an economics textbook, so we simply report a substantial body of economic theory as follows. The market may be thought of as a signalling system which coordinates the decisions of the various actors in an economy. It has two key features. First under certain circumstances (key features to be outlined shortly), the price signals reflect the social value of the resources being used or traded. Second the signalling system is self-enforcing, in that the actors have a practical selfinterest in obeying the signals.

The Fallacy Of the Generic Manager

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Appendix to Chapter 9 of The Commercialisation of New Zealand

Keywords: Governance; Health;

A central notion of the New Zealand reforms of the 1980s and early 1990s was that an able manager was capable of managing any agency in the private or public sector. This has two implications. First, it suggests that all economic activities are broadly the same, or may be treated so for policy purposes, since the required management skills and approaches are not sector specific. Second, it encourages the replacement of specialist managers, who had typically developed in the sector, with generalists who had not, but who would be loyal to the managerialist philosophy and anxious to impose it on the institution.

The Health Reforms (and the Blitzkreig)

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Chapter 9 of The Commercialisation of New Zealand

Keywords: Health;

Undoubtedly there was at the end of the 1980s a widespread perception that there was a problem with the health system, although in retrospect this seems to have been a grumbling rather than a deep discontent. When the reforms were being put in place the public indicated they were more satisfied with the existing structures than their earlier surveys has shown. Every health system in the world appears to beset with difficulties, which ought to be a warning to reformers that there are no easy solutions.

GLOSSARY OF TERMS IN SOCIAL COST ESTIMATION OF SUBSTANCE ABUSE

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This was published as an appendix to E. Single, D. Collins, B. Easton, H. Harwood, H. Lapsley, & A. Maynard (& R. Bowie) (1997) International Guidelines for Estimating the Costs of Substance Abuse (Canadian Centre for Substance Abuse)   Keywords: Health   Forward Each discipline has its own terminology. In an growing interdisciplinary area as…
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Up in Smoke, Down the Drain: How Tobacco Use and Alcohol Abuse Cost Us $39b

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Listener 21 June, 1997.

Keywords Health

New figures released this week indicate that tobacco and alcohol abuse cost the nation far more than hitherto thought. In my report The Social Costs of Tobacco Use and Alcohol Misuse, I estimate that the abuse of licit drugs costs the nation $38.6b(illion) in 1990. Some $22.5b is attributable to the costs of the use of tobacco, while $16.1b arises from the misuse of alcohol.

Health Disservice:

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We Spend More on Health Care. Where Has it All Gone?
Listener: 12 April, 1997.

The great twentieth philosopher, Karl Popper advised scientists to be aware of how the scientific problem with which they are concerned changes over time. The same applies to policy advisers. Policy problems change, so the unaware adviser or politician may be trying to resolve an outdated issue.

Waiting for the Doctor

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Emphasis on Finance and Waiting Lists Helps Obscure the Real Problems in the Health System
Listener: 15 June, 1996.

Keywords: Health;

Bill English, just appointed Minister of Crown Health Enterprises (CHEs) commented “when we ask people what they mean by health reforms they say waiting lists. If we can limit the debate to waiting lists then we have essentially won the argument about the health reforms.” The minister seems to have meant that if the government can avoid having to defend its structural changes – such as the top heavy administration and requiring each CHE to be run for profit, then the government could pour money in to reduce waiting lists, and obtain political kudos.

A Healthy Prognosis

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Twenty four Principles for Salvaging the Health System.

Listener: 11 November, 1995.

Keywords: Health;

It is the practice of this column to focus on explaining underlying economic analysis, rather than policy prescription. Typically, when I have to cut for length a column I have written, it is the policy that goes first. However we have got into such a muddle over our health system that this column breaks its practice and simply sets down a set of policy principles. (There are a number of areas which I have not discussed, because they are non-controversial – like that the biggest single health gain would be if we could abandon smoking.)

A Quiet Revolutionary: Eru Woodbine Pomare: 1942-1995

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He Worked for the Health of all New Zealanders
Listener: 18 February, 1995.

Keywords: Health; Maori;

Eru Pomare, who died suddenly in January, had an impressive whakapapa. A great-great grandmother, Kahe Te Rau O Te Rangi, was one of the few women to sign the Treaty of Waitangi; another, Maora Pani, saw a Captain Cook arrive; his grandfather, Sir Maui Pomare, a doctor and MP, was central to the first Maori health revolution at the turn of the century, which saw a dying race recover in vigour and numbers; his grandmother, Lady Miria Woodbine Pomare, who had a major influence on his life, deserved her own entry in The Book of New Zealand Women, the entry being written by her most eminent grandchild.

Cost Effectiveness and Prescribing: What the Young Prescriber Needs to Know

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Paper to “The Young Prescriber in the Therapeutic Milieu”, ASCEPT Satellite Program, December 4th, 1994, Published in “Australian Prescriber”, Vol 19, Supplement 1, 1996, p.25-27.   Keywords: Health;   Introduction   Crucial to the health economist’s perspective, it is unethical to be wasteful – to use unnecessary resources. [1] Such inefficiency means that resources that…
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Taxing Alcohol

This entry was posted in Health, Regulation & Taxation, Social Policy on by .

Presentation to “Perspectives for Change”, a conference convened by the Alcohol Advisory Council of New Zealand at Ohinemutu Marae, Rotorua, 20-23 February, 1994.

Keywords: Health; Regulation & Taxation; Social Policy

Given the brevity of the time available, this paper simply states a series of propositions about using taxation as a means of regulating alcohol use. The presenter has long been an advocate of an appropriate level of tax on alcohol to limit abuse and to pay the social costs of the abuse. While reaffirming this position, the paper is directed to the thesis that taxation for this purpose is a limited policy instrument, and that other instruments will have to be increasingly used if we want to obtain the socially optimal level of alcohol consumption. This presentation summarizes a series of papers on the economic regulation of licit drugs, which are listed in the appendix. This work draws on the parallel literature on the use and abuse of tobacco, where the similarities and differences are instructive.

Prostate Economics

This entry was posted in Health, Listener on by .

Listener 20 February, 1993.

Keywords: Health Economics

The recent outburst over the relative importance between prostate cancer and cervical cancer has numerous aspects to it, some of which illustrate economic principles. Most people will be aware that women are prone to cancer of the cervix, and that regular examination can identify pre-cancerous conditions which usually can be simply treated to prevent cancer. The prostate gland in men’s lower abdomen – the location is presumably the reason the parallel is drawn – is also prone to cancer. Prostate examination can identify a cancerous condition but, and this is what is crucial for the economic analysis, treatment at this stage is not nearly as effective as treatment made after a positive cervical smear test.

It’s in the Blood

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Listener 19 December, 1992

Keywords: Health;

Richard Titmuss’s The Gift Relationship: from Human Blood to Social Policy is one of the most insightful social-science texts of the 20th century. In it he shows that how a community handles its blood-transfusion service is a paradigm for its handling of overall social relations. Which makes it all the more telling to step back from the current row and place the quality of the blood supply in the context of the total health service.

Fences and Ambulances: an Economist Looks at Family Policy

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Paper for ‘The Children’s, Young Persons and their Families Act -A Review’, A Public Seminar. Palmerston North College of Education, Friday July 10, 1992

Keywords Health; Social Policy

It is a curious, if instructive, oddity that our most famous quotation about health promotion does not appear in the Heineman Dictionary of New Zealand Quotations. We talk about the need to put fences at the top of the cliff, but the thrust of our social policy is the ambulance at the bottom -although in recent years it has been more like a cardphone from which one can ring a private cab. Fences and ambulances represent quite different ways of responding to social policy problems. The more erudite might refer to holistic social policy versus pathological social policy.

Economic Instruments for the Regulation Of Licit Drugs

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Paper for the Perspectives for Change Conference, sponsored by the New Zealand Drug Foundation and the Alcohol Liquor Advisory Council, 25-27 November, 1991.

Keywords Health, Taxation & Regualtion

This paper does not pursue the ‘why’ or ‘whether’ policy issues of the additional regulation of licit drugs such as alcohol and tobacco, except insofar as that is relevant to the ‘how’ of regulation. The paper focuses on only one aspect of the how, the use of ‘economic instruments’ of regulation.

Blood Brotherhood

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Listener 8 March, 1980.

Keywords: Health; Social Policy;

Legislation passed in 1979 made it illegal to buy or sell human blood, except with the consent of the Minister of Health. Is this not another example of the government over-regulating life? Did not Gerald Ford, ex-president of the United States, part-pay his way through university by selling his blood? Given the miserable level of student bursaries, is the prohibition on selling human blood yet a further attempt to ensure that future New Zealand prime ministers will not have a university education?