Like most ideas from career politicians, National’s cancer announcement contained enough truth to be credible. But the proposed solutions (like Labour’s at the last election) are pure politics and owe more to internal polling and focus groups than what actually works. Our health system isn’t perfect and much could be done better, but National’s proposal is definitely a step in the wrong direction.
There are variances in hospital treatment across the country that can’t be explained by ‘local choices’. For example, rural areas don’t have the same access to some healthcare services – particularly highly intensive, tertiary services. But on the flip side, some rural areas have far higher rates of minor operations than major centres.
What is the reason for these differences? Essentially, it is due to the District Health Board (DHB) model Labour implemented in 2000. We effectively have 20 different health systems around the country, each with a unique offering. The offering is partly determined by the local population, e.g. Counties Manukau has much higher rates of diabetes, and by what the DHB can provide with the staff and kit that they have. As a result, smaller DHBs have to ship people off to the big cities for serious conditions, like cancer, but have far higher rates of routine operations, e.g. for hips and knees.
So yes, there is a postcode lottery, and it works both ways. City slickers get much better care for life-threatening conditions, while country bumpkins are more likely to get routine treatment that improves their quality of life.
Why Focus on Cancer
But why focus on cancer? What about heart disease, diabetes, or strokes? Or even better, why not focus on the myriad of ways to prevent all these health problems?
Our health system will never have enough money to treat everything. Demand for healthcare is basically limitless, so trade-offs will always be necessary. Just look at the United States, which spends twice as much money as we do, but somehow has worse health outcomes. Once we realise this, if we increase funding for one condition, another part of the health system misses out.
So why has National focussed on cancer? I’m betting this decision isn’t based on evidence or the best return for our health dollar, but rather a cynical decision based on polling. This may not seem so bad, until you think through the implications. Who votes, and who votes for National in particular? Generally speaking: older, richer people who already live long lives. It should be no surprise that these are the people who get cancer.
So what about people who don’t vote, such as younger, poorer people? These people are more affected by diseases like rheumatic fever or diabetes. It is noticeable that National’s announcement doesn’t address these diseases.
This announcement may be good politics, but it also illustrates why the gaps in our society are widening rather than narrowing.
Where Should we Spend our Health Dollars?
There needs to be some room to customise services for the local population and the issues they face but, beyond that, people should have access to similar treatments wherever they are. The question is which treatments should we fund?
Generally speaking, our health dollars should go where they have the best impact. Then our health system would focus much more on prevention. After all, an ounce of prevention is better than a pound of cure. Or as the evidence says, every dollar invested in prevention has the same benefit as four dollars invested in treatment. What is more, a focus on prevention would particularly benefit younger, poorer people.
The only part of our health sector that spends money according to the best returns is Pharmac. And yet, National’s cancer announcement would take this power away from Pharmac. Much like its Roads of National Significance policy, National would force Pharmac to spend a certain amount of money on cancer. And while $50m a year for cancer drugs sounds great, how much good could Pharmac do by spending that money where the evidence says it is needed? How many lives could be saved from other diseases?
The rest of the health system needs to operate more like Pharmac, not less. While National is right to draw attention to the postcode lottery, its solutions are simply another case of politicians tinkering with the health system. Above all, National should keep its mitts off Pharmac.