ADDENDUM: PROGRESS ON WAITING LISTS – August 2022
As predicted back in May, the expert committee’s action proved ineffective. Former DHBs were told by the Expert Committee they need to book everyone in for surgery (stellar advice!)
And… Not much else happened: https://www.rnz.co.nz/news/ldr/473204/south-auckland-s-elective-surgery-backlog-up-251-percent-in-year
ORIGINAL POSTING FROM MAY:
I can’t really say I’m a fan of the current round of health reforms:
- The “problem statement” for the reforms seems to miss 99% of what are the issues with the sector. Nothing about the sector’s deficits, nothing about declining productivity, light skim on access issues, nothing about service quality, nothing about workforce or provider incentives, nothing about performance over time …
- No evaluation was done on why the existing sector failed in the first place (see above).
- There’s no theory around the new institutional design: what makes centralising an entire industry under ministerial command and control necessarily better than what we’ve got?
- The patient/customer has no visibility in the new design. How are people going to express their health demands in the new system?
An over-emphasis on ethnic-based institutional reform without at least some attempt at an introspective evaluation of the last two decades worth of ethnic health inequality initiatives, marks this reform as more ideological-driven then concern for bring about real health inequality change.
The sector design is about locking in ideological power structures into control positions. Its not about individuals and their health needs. Its about power, privilege, and cementing in the control of a new ethnically-based group of politically picked elite.
This reform is a sham. Its going to lock in inequality. Those in most need of health care and the taxpayer are going to pay the cost of the government’s ideological folly.
WAITING LIST SOLUTIONS
So I was unsurprised by the latest health initiative to address waiting lists. In the absence of action, the Minister of Health has formed a Waiting List Committee.
This “high-powered taskforce” will “work-up the national plan for planned-care”.
The Minister plans:
The taskforce will support district health boards to take whatever short-term measures they can to reduce waiting times.
How’s it going to do that? Are its eminent members going to actually deliver the services themselves?
In other words, its not going to DO anything. Its going to meet. And discuss. And meet again. And issue a paper. And meet again. And discuss….
But it looks like the Minister is doing something. And for public presentation reasons, when reported through the media, that’s all that counts.
PRACTICAL SOLUTIONS FOR ADDRESSING THE WAITING LIST
Waiting lists should be seen for what they are: excess demand for health care, over a current ability to supply, and policy directed towards addressing both of these demand and supply conditions.
On the demand side, what’s the nature of the severity? Are we looking at cancer patients who cannot get treatment, or are we looking at respiratory patients who have lower quality of life?
What’s our theory for rationing health care: just because you’re not explicit about how care is rationed, it doesn’t make an implicit and existing rationing system simply “go away”.
The existing waiting list might actually be the logical expression of an implicit rationing system that the Minister is fully aware of but deliberately seeks to overlook and leave unaddressed.
… Or left overlooked and unaddressed by a sector-based eminently-qualified expert committee…
On the supply side, can we expand the workforce through addressing supply-side constraints; for example, revisiting existing restrictions on who can deliver what type of care?
I’m looking forward to seeing what this new Taskforce ultimately comes up with, but I’m willing to place bets that its advice will be thick on intentions and desires, and thin on theory and evidence-based advice for testing initiatives for sector-based change that delivers to the health demands of the sick and those in need.