The desirability of part-payments for healthcare

Treasury announced:

Inaugural Treasury University Challenge Winner Announced The winner of the New Zealand Treasury’s inaugural University Challenge is Sarah Shier, a Master of International Business student at the University of Auckland.

Her essay on Health and the possibility of co-payments was judged the best among entries submitted by students from all of New Zealand’s universities and from a range of disciplines. Entrants were asked to write a 2000-word essay to answer one of three questions on Crown assets, health, and overseas investment.

“The calibre of Sarah Shier’s essay and those of the other finalists was very impressive,” says Deputy Secretary for Strategy, Change & Performance Bill Moran.

“In assessing pros and cons of extending part-payments in our health system, Sarah showed both sides of arguments and brought together evidence from several sources to make her case. She also looked at how different socioeconomic groups might be affected, anticipated issues, and put forward measures to address concerns. It was high-quality work and I congratulate Sarah on her success.

“This competition has been a success for the Treasury too. We wanted to give university students a feel for the range of work the Treasury does and let them test their analytical skills on real life policy issues. We also wanted to reward excellence in public policy analysis and the University Challenge was a great chance to do this.

“After this year’s success the Treasury is looking forward to running the University Challenge again in 2014.”

Winner Sarah Shier will receive $2,500 towards her university fees for 2014.

Well done Sarah. Her essay is here. Some extracts:

Increasing co-payments for costly medications creates the opportunity to improve patient access to clinically effective medicines. Additionally, expenditures would be reduced as patients opt for preventative treatments over costly hospitalisations. Co-payment reform would also address socioeconomic and ethnic inequalities in the healthcare system by ensuring that subsidies are provided for those who need them the most.

Nonetheless, if not structured correctly, increased patient payments may exacerbate ethnic healthcare inequalities in the status quo. Furthermore, policies ought to continue subsidising preventative care in order to reduce long-run healthcare expenditures.


Medical professionals argue that PHARMAC’s rationing policies have limited the availability of effective medications within New Zealand. A 2008 report indicated that “New Zealand has 84 fewer innovative medicines funded than Australia.” Limited availability of blood pressure and lipid level medication can be costly in the long run as patients seek more expensive treatment for largely preventable cardiovascular conditions. Cardiovascular disorders accounted for the largest percent of “avoidable hospitalisations” within a Canterbury Hospital study.

Increasing co-payments for medications that benefit patients but are restricted in the status quo would improve the quality and efficiency of the healthcare system. Funding limitations have driven PHARMAC to fund some medications for high risk individuals only. However, expanded usage of pharmaceuticals such as statins may benefit lower risk patients and strengthen the healthcare system by preventing unnecessary costs in the long run. Co-payments could be applied to drugs such as statins that are widely beneficial but expensive to provide.

And on targeting:

Although funding for low-income healthcare has increased, a disproportionate amount of current expenditures are spent on high decile areas. Since the late 1990s, healthcare funding has increased more for higher income deciles than the more needy lower income categories.

Increased expenditures on broad initiatives—such as the community-based Primary Healthcare Strategy— have been largely responsible for the discrepancy between deciles. As a result, combined spending on decile 1-5 areas dropped to 54% in 2010.

Under a co-payment reform plan, subsidies could be targeted towards low-income groups to ensure equitable treatment. Increased patient payments could be designated for higher income individuals with the means to afford a modest increase in their current co-pay.

I believe it is sensible to target health care subsidies to those on lower incomes, and have those better off pay for a larger proportion of their own health needs.

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