The private healthcare system relies on the public system
when things go wrong, and should be more transparent about its
fees, Prof Robin Gauld said in a lecture in Dunedin last night.
In his first professorial lecture, Prof Gauld asked if the
public health system met the aims of the ''visionary'' 1938
universal healthcare law. As the 75th anniversary of the
Social Security Act approached, it was timely to ask whether
trade-offs made to appease the medical profession should be
able to stymie the health system today.
The government of the day allowed doctors to set fees in
general practice and to practise in both the public and
private sectors, because the doctors were reluctant to
relinquish this right. However, the doctors' parent
organisation in Britain held the opposite view.
Unusually, New Zealand had no method for setting private
fees, which raised questions over whether these differed from
fees in the public sector. In some countries, they were the
same, which promoted equality between the two systems.
''We need debate around private fees, in which there is
little transparency, especially when ...
"private specialists rely on publicly subsidised systems for
patient referrals and public hospitals for back-up and
support if things go wrong.''
Some New Zealanders could not afford GP appointments, or to
see specialists privately, and could need to wait until they
were sufficiently unwell to warrant treatment in the public
''I don't think this was the intent of the original [law];
nor do I think it's what most New Zealanders want today.''
Because of its two-tier structure, New Zealand's health
system lacked integration between services, despite having
the ingredients for co-operation. This had been demonstrated
in recent research on Southern Primary Health Organisation's
Care Plus programme for people with chronic illness, he said.
Prof Gauld also criticised the district health board system,
saying the public had little interest in the elections and
the system did not necessarily deliver people with the right
skills. He also spoke about the troubled teacher payroll
Novopay, saying the saga had renewed interest in his book on
IT failures Dangerous Enthusiasms. Novopay appeared to have
the ''eight habits for highly effective IT fiascoes'',
including early warning signs all was not well, he said.
Prof Gauld is the director of the Centre for Health Systems
at the Dunedin School of Medicine. He is a professor of