Health experts predict more collaboration between public and private sectors, and ACC

That’s from Des Gorman, a University of Auckland Emeritus Professor of Medicine, who says covid-19 is creating a long tail of non-covid illnesses and the public health system will increasingly need to buy care from the private sector. “Otherwise only the desperately ill will receive care or there will be waiting lists for Africa.”

A vocal critic of the upcoming health reforms and the government’s focus on structure rather than customer outcomes and delivery, Gorman was speaking as part of a recent panel discussion, hosted by the Financial Services Council, on the future of the New Zealand health system.

He said there was already a level of interdependence between public and private healthcare and ACC, but this would have to be ramped up.

The private system would increasingly be used for high-tech care, for example, and ACC was also likely to source its care from the private sector as it couldn’t wait for public health to deliver.

All this will likely lead to a bottleneck in accessing care in both the public and private systems as the government’s reforms begin to kick in.

Louise Zacest, CEO of insurer UniMed, says backlogs in the public sector will clearly have a flow-on effect in the private system. “As insurers …. I think we could see some challenges over the coming period of capacity constraints, from both workforce and facility perspectives.”

Nick Astwick, CEO of Southern Cross Health Society, says 80% of New Zealand’s future healthcare costs will come from 20% of the population.

Rather than changing the structure of the system, as the government is doing, Astwick backs Gorman’s view, saying the focus should be on reforming the delivery of healthcare with the emphasis on customer outcomes and innovation. Our healthcare system is actually a ‘sickcare’ system, he says, and neither the public nor the private system is sustainable in the longer term.

“It is not unrealistic to say that both the public and the private are unsustainable….In the private system, the price is increasing largely because the system is geared to efficiency. Efficiency and utilisation drive premium prices.

“In the public system, the main drivers, particularly on the demand side, are the aging demography, chronic disease and the price of technology. When demand is going to overwhelm a fixed supply, it is technically unsustainable and that’s what [is happening] at the moment. We have an excellent, highly capable workforce, but the system is unsustainable,” Astwick says.

As examples of public health systems that work, he cites Germany, Switzerland and Japan, where governments have focused on the ‘systemisation’ of healthcare delivery.

New Zealand must also develop the ability to scale innovation, Astwick says. That’s the only way through an unsustainable position where demand is overwhelming supply. Incentives for the desired outcomes needed to be clear and funding needed to align with those outcomes.

On the issue of the ‘right’ to free public healthcare in New Zealand, Zacest says we need to be explicit about what we expect from the public health sector.

“We need a good, strong, robust health system for New Zealand but there needs to be clarity. The default is rationing in the public system through well-developed clinical guidelines, but they are not explicit for consumers,” she says. “If they were, people might understand and be able to make decisions.”

Astwick says education and health should never be political footballs. There are some rights, he says, but that doesn’t mean a universal system because there is not a bottomless pit of money. The country needs a “mature conversation” about access and funding as the public system cannot deliver everything.

“But I still feel New Zealand should be fighting for its rights to ensure there is a provision, so we don’t end up like the basket-case which is the US, where the emergency system is really the health system for a large amount of Americans.”