Prescription For Change Presentaition by Gareth Morgan
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Prescription for change is a presentation by Gareth Morgan on ways to fix New Zealand's health care system. Prescription for chage is the follow up to Gareth Morgans book - Health Cheque
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Prescription For Change Presentaition by Gareth Morgan
- 3. … For Fewer Thrills
- 4. … For Fewer Thrills
- 6. Please Sir… Can I Have Some More?
- 7. Diabetes • 5% population diagnosed • 2% population undiagnosed • Rising even faster than predicted • 50% diagnosed managing condition • Lower for Maori & Pacific • Lifetime risk 9% Pakeha vs 25+% M & PI • Average loss of life for Maori & Pacific = 12 yrs
- 8. The Good: • System does well on oily rag • Pharmac, primary, A&E The Bad: • Spending more, getting less • Demand is unlimited • More is coming • Not a universal “all you can eat” system - rationing already exists The Unavoidable: • Economy is major constraint
- 9. Prescription One: Stem the Tide
- 11. Extending Lives ≠ Saving $ Saving Lives ≠ Saving Money
- 13. Prescription Three: Improve Delivery Structures
- 14. The Political Trade-off Prevention Cure Long payback time Rule of rescue More Community Care More Hospitals Multidisciplinary Teams More Doctors More Lifestyle Mgt More Operations “Live longer, healthier and “Better, sooner, more more independent lives” convenient”
Editor's Notes
- Apologies from Gareth – the late Sir Paul Callaghan asked him to help run the Transit of Venus conference. Quick refresh of Health Cheque – Gareth presented the findings 2 years ago, then we’ll see where we got to since then.
- Health costs have been growing 3x faster than our income since the public health system began.
- This graph shows all countries life expectancy against their healthcare budget. Despite the escalating costs, all developed countries are seeing less and less return for the investment. Most measures show a similar result. Note the outlier of the private US system which overtreats the rich (to the point of harm) and undertreats the poor, leading to worst possible outcomes.
- NZ is above the line – so we do relatively well for the amount of money we spend on health. Others spend more and live longer. If we want to afford as many operations as Australia then we need an economy like Australia’s. Currently NZ spend is around OECD average as % of income. In money terms it is lower than OECD average, but we get outcomes that are generally above OECD average. So NZ system does well on an oily rag. This is because of our focus on prevention, Pharmac and good emergency care.
- But for all that good stuff costs will keep rising – why? When will we break? When combine public health and superannuation the costs of supporting baby boomers will soon top 20% of GDP. Gens X and Y will leave. Note that this is a conservative estimate. In next decade we face a doubling of demand but resources and labour can only be increased by a maximum of 40%. What is driving the increases?
- Drivers of cost increasesMost people say ageing population but the real driver is public expectations! People expect more treatment for the same conditions than they have in the past. Other drivers:AgeingNew technology and supplier induced demandProductivityChronic illnesses
- Last few stats well out of date – probably higher by now
- Summary of Health Cheque findings.So what do we do about them? Following conversations with medical staff around the country we wrote the follow up Prescription for Change.
- This is where the currentGovt has been most lackingNeed to face downsides of treatment – more conversations about medication & whether it is right. Studies show that when people are fully informed about the downsides of treatment they will often choose not to be treated. Particularly need a conversation about end of life care. Incentivise primary providers to prevent and manage chronic conditions. Capitation some success, need more. Will come back to this. Leadership in public health – regulate, educate, price, discriminate
- Heart disease and strokes coming down but diet is still major cause of death in NZThat is why our next book will be on Nutrition – out later this year. Diabetes to double by 2021 – hospital treatments to triple Other public health not far behind – tobacco & exercisePrimary and prevention return on investment four times better than secondary in terms of years added to life per dollar invested. But what about the Horn Report? It said prevention doesn’t save money. Both these statements are true, how is that possible?
- Horn Report focussed on saving money, we were focussed on return on investment. Prevention not please the bean counters in Treasury. Obese and smokers actually reduce costs to the Crownbecause they die soonerPrevention has long lead time and doesn’t save money – in the long run all treatment has a 100% failure rate. Death is the real cost driver because we throw the cheque book at people during the end of their lives. Prevention IS better than cure but the other medical aphorism “the rule of rescue” comes up trumps!Really cheap prevention techniques tend to involve the greatest impact on liberty – regulation and taxation. This accounting approach does not take into account productivity benefits of longer lives!
- We already have rationing. Not just waiting lists! We have designed a system that makes it impossible to get what you want. As a result you get what you ask for. The squeaky wheel gets the oil.Who misses out? Young brown boys. We recommend formal rationing, apolitical with a board to overseeLed by Health sector professionals BUT WITH STRONG EVIDENCE BASE!Operates like Pharmac with feedback from evidence, docs and publicFull transparency
- National Govt done some good stuff in this area, but fiddling at the edges – admin is tiny proportion of budget so big savings disappear quickly into the gaping maw of unlimited demand. Little hospital that could:Subscale, expensivePass on serious patientsPlague of locumsOver deliver minor proceduresNeed to rethink what our health system is:Fewer, bigger hospitals, more primary careUse scarce doctors wisely, devolve more tasks to nurses & other health professionals – now is not the time to get precious about occupational licensingMore lifestyle managementUse technology as best we can given remote locationsHow? Cultural change, give docs incentives to reduce costs. No-one is going to lose their jobs, but we can’t keep going the direction we are.
- People see their local hospital and doctors as equating their health system. This is outdated. We need to re-educate the public to want the health system to keep them out of hospital as long as possible.