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Speaker: The system's pretty good, the expectations are crazy

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  • giovanni tiso,

    t's PAS heresy to suggest that I was overweight because I ate badly and didn't exercise and lost weight by changing that, but it does happen to be true

    Nobody I think is denying that 'eat less and exercise' is good advice - well, the Listener did once, in the penultimate issue of our subscription if I recall correctly, but I digress - and that it shouldn't have to be competing with so much conflicting advice from the food industry, and pressures to work long hours in sedentary jobs, and the commutes in our badly designed cities... but I think you'll find that in past discussions on these very boards it has too often devolved into absolutism - what Danielle said above* - or worse, puritanical crap all-too-easily morphing into the implication that it's your moral duty to be healthy and thin. I think that's where the resistance to the 'look at me, I run for miles every day and eat only celery' line comes from.

    *I think T-Shirt One in the PAS merchandising line should read What Danielle Said on one side and What Stephen Judd said on the other. I'll take one in beige, size M (for I eat little and exercise).

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Peter Ashby,

    Dyan is right about conventional sport alone not making you fit. I gave up playing soccer at 14 (I was the goalkeeper btw) partly because I was clearly the fittest member of the team. When at training the coach would say '3times round the field to warm up', I would be finished and only puffing slightly while the rest were still on lap 2 (I don't exaggerate) with my fullbacks at the back of the pack. Then i would repeatedly find myself in 1 on 1 or even 2/3 on 1 situations because said backs couldn't be arsed to run AND I would be blamed for not saving those goals.

    Which is why I threw it in and took up running.

    I take it fresh foods will be cheaper?

    Food doesn't have to be fresh to be good for you. Frozen veg are often more full of nutrients than their fresh equivalents as they are frozen very soon after harvest. You have to go to home grown veg to match it. Also tinned chick peas and beans in water are both cheap and good for you*. I do a mean, and fruity, chicky pea curry even when there's no (low fat) coconut milk available.

    *not as cheap as dried versions of course, but they are more convenient and require less advance preparation. I eat both sorts.

    Dundee, Scotland • Since May 2007 • 425 posts Report Reply

  • andin,

    I take it fresh foods will be cheaper?
    Food doesn't have to be fresh to be good for you.

    Thanks Peter. I know this
    But what I was trying to point out is taxes on low nutrition value foodstuffs would seem to be a pointless exercise if, even when it is slammed with tax, an important part of a healthy diet(fresh food) will still be more expensive than it.
    Even before it could be nannystated.

    raglan • Since Mar 2007 • 1881 posts Report Reply

  • giovanni tiso,

    Ah, but the problem there is that even if you taxed junk food, it would be very hard to put the money into subsidising the purchase of fresh foods, unless you decided to *gasp* reintroduce agricultural subsidies.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • andin,

    Preventative healthcare would seem to be in danger of shooting itself in the foot.

    raglan • Since Mar 2007 • 1881 posts Report Reply

  • jb,

    Given the disparity between relative health spends between Germany and NZ (NZ spends 50% more per head than Germany), can someone explain to me why health care in NZ isn't significantly better?

    In Germany:
    There IS no waiting list for an ENT consultant (at least 6 months in Nelson/Marlborough with only 4 specialists for the region, with significant numbers not even accepted on the list), this IS no waiting for a hip replacement (3 months from referral to procedure, including 4 weeks lag for a blood bank donation for own use) , there IS no waiting for cancer treatment after diagnosis, there IS a higher level of preventative medicine

    And

    There IS no rationing of medical services.

    Whether such a scheme is sustainable in the long-term, with an aging population and exploding pharmaceutical costs (it's not btw) is another discussion, but my experience of both systems leads me to believe that either a) the figures are questionable or b) the system in NZ is being run by incompetents who tolerate an inefficient system where a bureaucracy sucks up huge amounts of funding that should be funneled towards primary and preventative care.

    a.small.town.in.germany • Since Jan 2007 • 86 posts Report Reply

  • Islander,

    "b) the system in NZ..."

    -got it in one jb.

    Also, the system keeps getting tinkered with by pollies, and there is never enough input - let alone consultation with workers@the-coalface(nurses, radiotherapists et al within the hospital structure) let alone primary healthcare givers - e.g GPs-

    Big O, Mahitahi, Te Wahi … • Since Feb 2007 • 5643 posts Report Reply

  • Ben.Shirmer,

    Given the disparity between relative health spends between Germany and NZ (NZ spends 50% more per head than Germany), can someone explain to me why health care in NZ isn't significantly better?

    I am not really sure, but one explanation could be that the bigger population makes it easier to establish specialised services, which are quiete expensive, in sufficient number, just due to the fact that the budget overall is a lot bigger.

    For these services there is a need for sufficient customers, so that they can work efficiently, which are a lot easier to attract, when they are located at a place where the transit between countries allows for additional customers.

    Welly • Since Nov 2009 • 46 posts Report Reply

  • Just thinking,

    jb & Ben - wildly off topic

    As the resident Germans here do you have any info on the Germans expelled from Prussia, now Poland?

    I have found a silence from some other sources I've asked & and shrill responses from others.

    It seems ethnic cleansing (either way) is not a particularly polite or precise process.

    We identify as Polish but have mixed Polish/German heritage and under Prussian Kulturkampf were incouraged to leave & did.

    The towns of Warmaria/Masuria-East Prussia that we were from are now populated by displaced Ukranians.
    From what I've found it seems many who share my maternal families identity were removed anyway or denied citizenship.

    It all seems very messy with no redeeming aspects to it on any side you care to look.

    I would greatly appreciate any info or pointers you may have.

    Putaringamotu • Since Apr 2009 • 1158 posts Report Reply

  • TracyMac,

    @PeterAshby - I didn't see your response to my comment for a while, but frankly, you can get stuffed. As Danielle said, you do not have the right to diagnose me over the internet.

    I go to the gym, I ride my bike, I don't puff when I walk anywhere. What might have worked for you will not work for the entire world. Perhaps it might, but that's what -research- should determine, not unsolicited drive-by evangelising diagnoses.

    Canberra, West Island • Since Nov 2006 • 701 posts Report Reply

  • jb,

    @ Just thinking

    Actually, I do. http://mainzdailyphoto.blogspot.com/2007/10/my-mate-christoph-233.html

    I can find out from Christoph if you'd like

    PM me via the blog

    a.small.town.in.germany • Since Jan 2007 • 86 posts Report Reply

  • jb,

    @ben.shirmer

    Economies of scale certainly play a role. A private (ie consultant's) MRI facility in a catchment area of say 300,000 population runs 6 days a week from 0700 to 2100. It's probably not the only one in the immediate region.

    And the next region with a catchment of >300,000 is a 30 minute drive.

    One must not forget: you're paying 15% of your salary for health care, with the employer picking up 50% of the tab.

    On top of that there's income tax - we pay a marginal rate of over 40%
    And pension contribution 10%
    And unemployment contribution 1.5%

    Big bucks

    a.small.town.in.germany • Since Jan 2007 • 86 posts Report Reply

  • andin,

    Just one thing still annoys me its the title, especially the second part.

    the expectations are crazy

    Did a sub editor (Does PA have those) chose it or is this a distillation of the authors assessment of the situation?
    The questions it raises for me range from
    Well when have peoples expectations not been crazy?
    Thru...
    Well not all peoples expectations are crazy, there are reasonable expectations. Aren't there?
    To...
    People are allowed to have expectations of their health care system, and it up to a government to meet those expectations where it can.
    If it cant, isn't there a roadmap to follow to inform the public?

    raglan • Since Mar 2007 • 1881 posts Report Reply

  • Bart Janssen,

    ...can someone explain to me ...

    One part of the explanation is that Germany is bigger. A significant number of pharmaceutical companies and medical suppliers ARE German. Hence it is cheaper for the German health system to buy German products than for the NZ health system to buy the same products.

    But another big part of it is lack of efficiencies in the system. I'm fairly sure the German people would not tolerate having the health system used as a football by incompetent politicians. That's no way to win a world cup.

    Auckland • Since Nov 2006 • 4450 posts Report Reply

  • Geoff Simmons,

    "NZ spends 50% more per head than Germany"

    Sorry, but this is wrong.

    Germany has a pretty good health system, true. Most of Europe does. But lets get real - they spend a LOT more. They are richer and spend more in every dollar earned. And they are up against the wall to maintain service levels - all of Western Europe will see big changes in the coming decade as their healthcare systems go broke. No silver bullet here folks. NZ system is pretty efficient internationally especially given our low income and dispersed population.

    You don't have to introduce agricultural subsidies to subsidise good food. Subsidies can go to the consumer rather than the producer. Although the demand for fresh or frozen unprocessed produce may be boosted - isn' that a good thing? And I am not suggesting that alone will make a difference to obesity. Again there is no silver bullet, like smoking it needs to be hit on many fronts simultaneously.

    I also agree with Bart about getting docs involved in prioritisation. This is one of the central messages of the book.

    But lets not get into bashing administrators. The best hospitals are where the docs and administrators work together well, that needs good administrators. Docs don't want to run hospitals. Admin spending is actually pretty low in NZ - shown by the paltry amount of money saved by the recently announced 'Horn' reforms which tacked 'out of control' administration - increasing healthcare costs will swallow the admin savings generated within 3 months.

    Wellington • Since Dec 2009 • 4 posts Report Reply

  • giovanni tiso,

    You don't have to introduce agricultural subsidies to subsidise good food. Subsidies can go to the consumer rather than the producer.

    How are you going to ensure that this money gets spent on fresh foods, instead of cheaper unhealthy alternatives? Do you think you're going to make everybody upper middle class by enacting tax cuts?

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Heather W.,

    There is a Fags and Fat Conference in Wellington today. Which on one level seems an interesting linkage as for some people the reason they gave for not being able to give up smoking was that they would gain weight. On the other hand the willpower/won't power triggers or addictive behaviours may have common aspects.

    North Shore • Since Nov 2008 • 189 posts Report Reply

  • Bart Janssen,

    But lets not get into bashing administrators. The best hospitals are where the docs and administrators work together well,...

    I get that large institutions need administrators and good ones. And many of the administrators we have in the various institutions are very good.

    My issue is that we have a culture that says administrators should be paid more and should make the important decisions (because they are paid more). Yes that is circular. Since administrators are often the ones making the decisions about who gets paid more it becomes even more circular.

    Yet some decisions (many, most?) require expertise that administrators (no matter how good) simply do not have. Some really good managers recognise when they need to let the experts make the call and when the managers need to butt out of the decision making. But too few.

    I agree the docs (or the engineers or the scientists or the lecturers or the teachers) don't really want to do administration. But that doesn't make them less important than the admin staff.

    Auckland • Since Nov 2006 • 4450 posts Report Reply

  • Kyle Matthews,

    I think you should distinguish between admin staff, most of whom won't be well paid, and management.

    Since Nov 2006 • 6243 posts Report Reply

  • jb,

    @ Geoff Simmons

    "NZ spends 50% more per head than Germany"

    Sorry, but this is wrong.

    Actually, figure 15 in the article shows exactly that (in ppp terms for 2000) and was the catalyst for my comment.

    I'm not bashing administrators per se.

    I do have issues, however, with a system where the "solution" for an error rate of between 8%-10% in prescription fulfillment - my pharmacist went as white as a sheet when asked about this value; she'd be worried if it was anywhere near single digit percentage figures - is to charge the end user a "clarification fee" (Nelson DHB), where a physician categorises a trapped lumbar nerve caused by getting up from a chair awkwardly as an ACC case ("It's cheaper for you that way") despite my having insurance cover, when it takes a pharmacy over 30 minutes to fill the prescription "because we can't find you in the system" and then give me 250 (!!) paracetamols "because it's only a bit more expensive for you than 50"

    I'd say that that's symptomatic of a broken system, one in which the NMDBH recently determined that they're performing "too many" discretionary procedures pro rata for their catchment area, so they're stopping doing that and performing the same procedures on patients from other DHBs from which they then derive income.

    These are the false incentives that make for inefficient outcomes in terms of dollars spent.

    And there must be some explanation for the fact that NZ is 3rd in the 2000 OECD ranking, behind only USA and Canada ahead.

    Shome mishtake, shurely?

    a.small.town.in.germany • Since Jan 2007 • 86 posts Report Reply

  • dyan campbell,

    Given the disparity between relative health spends between Germany and NZ (NZ spends 50% more per head than Germany), can someone explain to me why health care in NZ isn't significantly better?

    I am not familiar with German health stats, but I can see from rankings in international tables that NZ's record in paediatric health is so woefully poor that I can correctly assume Germany has better stats without even bothering to look - seeing where NZ falls in the ranking tells me enough.

    Preventable Diseases in NZ Children
    Among OECD
    countries NZ was 24th out of 25th for Health and Safety. This information was no
    surprise to health professionals working with children in NZ.

    For serious skin infections our rates are double other countries.
    For whooping cough and pneumonia our rates are 5 to 10 times those of other
    countries. For Bronchiectasis our rates are 8 times those of Finland, the only
    other country studied. For Rheumatic fever our rates are 13.8 times higher than
    other countries.

    For every paediatric hospital admission there will be tens of thousands of dollars spent, and in some cases such as bronchiectasis or rheumatic fever for instance - where the damage is going to cause health problems that will severely compromise their health as adults throughout their lives, the cost will run to hundreds of thousands of dollars per patient. So a lot of money is spent treating acute illness when the real savings would be in improved housing, improved nutrition and improved rates of immunisation.

    If Don Brash thinks the way to NZ achieving prosperity is to stop funding medical access for poor kids, he needs to have another look at the sums.

    auckland • Since Dec 2006 • 595 posts Report Reply

  • Geoff Simmons,

    @jb

    I can see the cause for your confusion. That graph is not for all health spending. It is for health spending on public health and prevention, i.e. smoking cessation etc. We spend more than Germany in this respect, but not on the whole health system including hospitalisation. This is the danger of publishing an extract!

    I agree with what you are saying on mistakes and the DHB system tho'. Mistakes drive 20% of our healthcare costs. Our system needs to invest in decent systems that prevent mistakes, like unified patient records. And we need to get the incentives right for professionals to get and keep us healthy.

    @ Bart Janssen

    I am pretty sure I agree with everything you say, I was just picking up on a relatively minor point. Admin bashing is popular with the Govt at the moment, but as the sole solution to our healthcare problems it is just hollow politicking. The savings from the latest admin reforms will be soaked up by healthcare cost increases within 3 months.

    @ dyan

    Agree completely with what you are saying. This is where our preventative effort needs to go. We could pay for this by having fewer provincial hospitals, and by caring for the elderly rather than treating them.

    @ giovanni

    I understand things like grocery and gym vouchers are currently being trialled.

    Wellington • Since Dec 2009 • 4 posts Report Reply

  • Sacha,

    caring for the elderly rather than treating them

    It's a big mindset change. The health system must stop trying to expensively 'cure' disabled people and concentrate its efforts on making sure supports are provided for productive everyday living. Or get another branch of public service to manage it; one without the conflicted thinking.

    That type of change will not be driven as Dyan said upthread by involving only transaction-oriented doctors or nurses in decisions, though they have wisdom to contribute. Public health specialists, epidemiologists, and dare I say disability strategists are also essential parts of the answer. Heck, even economists seem useful :)

    Ak • Since May 2008 • 19680 posts Report Reply

  • Sacha,

    Mistakes drive 20% of our healthcare costs. Our system needs to invest in decent systems that prevent mistakes, like unified patient records.

    The Quality Improvement Committee has been tackling some of those.

    That focus will be picked up by the new quality agency proposed in the Horn Ministerial Review Group report, whatever form that eventually takes. However, that's clearly not enough. A focus on quality - especially from a consumer perspective - needs to be embedded in thinking and action throughout the whole system.

    Ak • Since May 2008 • 19680 posts Report Reply

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