National’s Health Discussion paper

National released yesterday its discussion paper on health.  Some key points are:

• Greater involvement by doctors, nurses and other health professionals in the public health system’s planning and operation
• Relocating some hospital services to Integrated Family Health Centres, which would provide a fuller range of services closer to patients
• Use of public-private partnerships to boost elective surgery availability and cut waiting lists
• Investigate bonding and student-loan write-offs to boost the health workforce

The full paper is 51 pages long.

Understandably some of the media focus has been the statement during the press conference that National does not plan to continue to cap GP fees.  I’ll touch on the process and the substance of this.

The political management has been a bit sloppy to not have this explicit in the discussion document or at least the accompanying material.   Any release of decisions or thinking should be done in a controlled structured way, not done because a journalist happens to ask the right question. This combined with the publicity over the policy to allow minority private ownership stakes in some SOEs makes it an untidy few days.  Again not that the substance is wrong (in fact it is good to see differences between Labour and National) but that it looks like policy is being revealed grudgingly.  The SOE stuff has been public for months and months and any questions on policy should always refer to the fact that this is not new.  MPs should have at hand that this was released publicly on x date by y, is on the website at z etc etc.

Anyway onto the substance of should GP fees be capped, and Tony Ryall answered this well:

“We think the Government’s price control affects the long-term viability of general practice. So people can have the price control, but they might not have a GP. That’s the reason we’ve indicated for a long time that we just don’t think they should have this.”

He said National would have a much more “trusting relationship and a relationship of mutual respect” with doctors, who had undertaken to pass on subsidies when they signed up for them.

And then John Key said:

National leader John Key also said fees would be controlled by “the market”. Asked what would stop rural doctors increasing their fees given they faced little competition, Mr Key said “country GPs aren’t exactly known for being rip-off merchants”.

Labour’s imposing price controls on GPs has been part a 20 year battle by Helen Clark (she tried in the 1980s) to effectively nationalise GPs and make them de facto state employees.  We’d be like the UK National Health Service and I suggest anyone who trumpets that service should be forced to go and use it.

The reality is we have a huge GP shortage, especially in rural areas.  The thought of GPs making themselves filthy rich because they are the only GP in say Haast is a joke.  We have real problems getting GPs into rural areas, even with the massive influx of foreign trained GPs.

GPs income relative to other professionals has, if I recall correctly, massively shrunk in the last 20 years.  It used to be a top profession to aim for, with top remuneration, but now some LLB students are earning more than a GP, before the med student even finishes study.

Another reason the state should not price set for GPs is not all practices are the same.  They have different property costs, different staff costs, different mixtures of patients, different average times per consultation etc.