“It will take time for the benefits of shifting health spending onto primary care in NZ to become apparent.” Oh yeah, we just need to give it a few more decades of Heleban administration, yeah, right…..

Aren’t there more useful statistics? For example, average waiting time between GP referral and seeing a specialist? I know that’s much more difficult to find than the big fat number on Vote Health, but that comparison is just plain useless.

Burt – people dying on waiting lists imply that they’ve already seen a specialist (or they wouldn’t be on the list). That’s another way in which the first specialist visit figure doesn’t tell us jack.

PhilBest, No, there are a whole lot more people there in that boat, believe me. At any time of the day there were hundreds of people sitting in the “emergency” waiting rooms waiting patiently for their number to come up, literally, because they were using the ticket system. It will take time for the benefits of shifting health spending onto primary care in NZ to become apparent.

Er, jafapete, what is the difference between THAT and what we have here, besides the fact that there are a whole LOT MORE people HERE in that boat?

http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10502429&pnum=0

PS If you’re in Auckland in May there’s a book launch you might like to attend.

[DPF: I end up in Auckland most months but never sure when]

Yes, was at Whitehead’s presentation in Auckland last week where he kicked off the productivity series. But having trouble finding the pdf icons to download the papers on the Treasury site. Have you had any luck?

And yes, we do seem to be shovelling money into a hole. But we must remember that productivity has always been a problem in the health sector if measured in terms of money/patient or similar. A professor of health economics explained this to me in the 1970s thus: they keep inventing devilishly expensive new machines and treatments… And this was just before CAT scanners and cisplatin treatment, etc.

In any case, it’s only one of a large number of measures of *output* (NB: not productivity, which is a ratio) in the health sector, and is meaningless without a lot of other measures, which is why Ryall will finish up looking like a twat if he tries to take on Cunliffe at question time using this data. Can we have the other measures so that we can have a sensible discussion?

If you look at the article that I have added to the discussion, you will see an analysis that uses some of the more useful actual measures of health sector productivity to show that, well, things improved under your lot as well as under mine. Not that I expect good news of this sort to get a good reception from the more rabid members of the kiwiblog right (Redbaited, etc), who have trouble dealing with any sort of cognitive dissonance.

But, yes, we do have shortages of specialists in some areas. It’s a world-wide phenomenon. I could say that National’s leading us down the path to a low pay economy in the early 1990s didn’t help things there.

PS It’s “fewer” people, as you know.

[DPF: It is only one stat, but really almost all the other surgical and hospital stats are the same. For a massive (think doubling in nominal terms) increase in expenditure, outputs and outcomes across the board have declined or only marginally increased. This is not just my view - Treasury has reported with great concern on this area. Anyone who argues we are getting value for the extra money is ignoring reality]

Try getting an operation without a specialist appointment/assessment. Oh I know Labour good – National bad… people die on waiting lists – it’s the price we pay for a Labour govt. Move on.

[DPF: Of course it is not the only output but it is insane to suggest that makes a comparison invalid - with that logic one could never compare any funding to outputs because they do not provide funding breakdown details. Especially valid criticism also when Labour campaigned in 1998 on increasing specialist appointments]

Had a close look at a hospital in L.A. last year, and it had an enormous, vast, huge “emergency” department, dealing with all the poor people who had no health insurance and finished up being hospitalised when their conditions became life threatening. Not something I ever want to see here.

People might find the article, “Do Hospital Bed Reduction and Multiple System Reform Affect Patient Mortality? A Trend and Multilevel Analysis in New Zealand Over the Period 1988–2001″ by Peter Davis, Roy Lay-Yee,Alastair Scott, and Robin Gauld in the December issue of Medical Care of interest. To summarise, the public hospital system has been quietly improving, regardless of the regime. (And, yes, that is the very same Peter Davis.)

I don’t have time to precis it myself, but here’s the abstract:
Background: The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern.
Objective: To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s.
Research Design: Trend analysis using both tabular and multilevel techniques.
Subjects: Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988–2001.
Outcome Measures: Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate.
Results: Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not
by reform phase.
Conclusions: Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes.

What was the efficiency differential between public hospitals and private hospitals at that time, and has it improved or declined since then?

DUUUHHHH !!!!!!!