Should public hospital cancer treatment have an unfunded -
privately paying - stream? Mathew Zacharias offers a personal
reflection on the debate.
In the past few days, several reports have been published in
the Otago Daily Times on an Otago and Southland District
Health Boards' discussion document to provide private
treatment for fee-paying cancer patients when some treatments
are not publicly funded.
It appears that our cancer specialists, those who have to
deal directly with cancer patients, seem to support this
concept.
As one would expect, the Labour Party and some of its
affiliated unions and some others have objected to this
recommendation by the health boards on the grounds that this
would lead to inequality in the public health system.
Essentially, they are suggesting to those who are desirous of
such treatments to get lost and to go somewhere else to get
such treatments.
Superficially, this argument sounds logical: equality is an
essential part of any well-functioning society.
Unfortunately, what is missing from the argument is a
person's right to have all acceptable treatments when
required.
What is equality without individual rights?
Let us put ourselves in the position of a person who has been
diagnosed with a major cancer such as bowel cancer.
Tell him or her that there is a treatment, which will be of
benefit and prolong life, but that such treatment is not
funded and is not available in Dunedin hospital - in fact it
is not available even in the private hospital in Dunedin.
Let us assume that this person is prepared to scrape up
savings for the treatment because survival is important for
the person and their family.
Let us tell that person the only option available is to go to
a private hospital in Auckland, for a few days at a time,
every three weeks, for six months, to receive the treatment,
often an intravenous injection of chemotherapeutic agents
under the supervision of experts.
Let us also hint that the only reason why such treatment
cannot be delivered in Dunedin hospital is because of a
political desire to proclaim equality in our health system.
What do you think that person would do? Accept that equality
is more important than anything else or get the first plane
to Auckland where the treatment can be administered
privately?
I am sure many people with serious cancers would sympathise
with this person's dilemma.
Most people with cancer may not be able to pay for additional
treatments, but it is unlikely they would disagree with the
choice to pay for the extra treatment.
Why can't the person have it in Dunedin, provided it is
privately funded and does not directly interfere with
treatment of other cancer sufferers?I have to admit that this
is, in fact, a personal story: I am the person who was told
three years ago that I had to go to Auckland for additional
treatment for my bowel cancer because the rules did not
permit me to have such treatment in Dunedin hospital.
The then minister of health was in no mood to break the code
of equality in the health system, even though his department
was unable to provide the treatment which many considered
standard follow-up treatment for bowel cancer at that time.
The good part of the story is that the Dunedin Hospital
management quietly overruled the minister and his department
and allowed me to have the treatment in Dunedin hospital,
provided I paid for everything and had the treatment after
hours.
I wonder whether all those individuals objecting to this type
of arrangement for cancer patients have ever thought about
the possibility that it could be them one day?As far as I am
aware, New Zealand is one of very few countries where
fee-paying patients are not allowed anywhere near the
entrance to a public hospital.
I am afraid there is very little to show for that in our
hospitals.
The waiting lists and treatments are managed much better in
most other countries where there is a public-private
partnership in existence.
Those who insist that private treatment should not be offered
in public hospitals should also insist that all modern
treatments should be made available in the public hospitals;
otherwise they are living in a socialistic utopian society.
Dr Mathew Zacharias is a specialist anaesthetist at
Dunedin Hospital.
