Years ago when I first came to live in NZ I did a considerable amount of work in the health sector. I have retained an interest both as an observer and as an occasional consumer of services.
Therefore I found this article by Atul Gawande at The New Yorker, very interesting.
The article begins:-
It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
That’s right US$3000 more than the average local earnings.
This article paints a picture of costs and health care that is grimly fascinating, though disturbing.
Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance.
The author examines why there are the differences. Part of the answer comes down to values. Part to governance.
But I would suggest that we should not be complacent here in NZ. A very large percentage of the NZ Government’s tax take goes on Vote Health, plus spending by ACC, health insurers and part payments by individuals to doctors and pharamcies. Most people would be surprised at how large the NZ spend is, especially in percentage terms.
This raises the question of whether there are lessons to be learned from organizations like the Mayo Clinic,discussed in the article. After all Vote Health has expanded considerably every year, but has the increase in spend been matched by a corresponding increase in effective delivery? We need to ensure that we spend smart. Just increasing spending is not of itself an answer.