The numbers don’t lie: how inequality is baked into the NZ health system
‘All New Zealanders should have equal access to the same standard of treatment’ was the pledge 80 years ago. The data reveal just how far we are from honouring that pledge, explain Carl Shuker and Robin Gauld.
Richard Smith, the irascible, brilliant editor for 13 years of the British Medical Journal, one of the biggest and most influential medical journals in the history of the planet, wrote something wonderful in 2011:
“It is not wholly fanciful to compare the Dartmouth Atlas of Health Care with On the Origin of Species. Both books … fundamentally changed our world view. Darwin’s book showed our descent from apes. The atlas exploded the belief that medicine is based firmly on science.”
It turns out healthcare isn’t maths. What Smith was talking about was a project at Dartmouth University in the US by a man named John “Jack” Wennberg. Not a conventional atlas at all. Wennberg’s atlas mapped how healthcare “varies”, and by doing so showed us – not just patients, but doctors – some challenging things. Challenging, in particular, to our perhaps naïve sense that the diagnosis of a health problem implies a treatment or course of further tests that’s basically the same for every person with that diagnosis.
In the US, Wennberg found, Americans were getting different healthcare depending not on what they needed or wanted, but on what was available to be given. You were more likely to get a CT scan if you went to a particular doctor, even in the same practice. You were more likely to get surgery if you went to a certain doctor. Numbers and kinds of tests, scans, surgical procedures, all varied by who was doing the recommending, independently of patient need. In places where more tests are available to be given they were given, regardless of need. One plus one equalled two or it equalled ten, depending on where you lived. This was called “practice variation”. The patterns were “chaotic”.
Well, that’s the US, you might reasonably say: a special case. A free-market healthcare model where healthcare costs more than anywhere on the planet and – shockingly for US exceptionalists – delivers results (including life expectancy) worse than most. Where a course of anti-venom for snakebite might bankrupt you. Where childbirth might bankrupt you. And where the discourse has degenerated so far that Rand Paul (junior Republican senator for Kentucky, and ophthalmologist) can be taken seriously when he says that if you believe people have a right to healthcare that “means you believe in slavery”.
In New Zealand we have a very different, and very special system of public health care. It’s called a Beveridge system, named for William Beveridge, architect of the UK National Health Service (the mighty and embattled NHS). Our public health care is provided by government and paid for with our tax dollars, with a small yet significant private sector for those willing and able to pay.