The term was coined by Canadian-British author Cory Doctorow to describe the deliberate, gradual degradation of online platforms and services, which lure users in with high-quality service, before locking them in and extracting all remaining value for shareholders, resulting in a poor user experience.
Roslyn Pharmacy owner Andrew Hou said he was a little dismayed when he first heard the term from some young people. After researching the term online, he discovered it accurately described what was happening to New Zealand’s healthcare system.
‘‘Enshittification describes what happens when systems slowly stop serving people and start serving scale, profit and efficiency instead.’’
He said more and more independent GP clinics, pharmacies, dentists and physios were being bought by chains with centralised systems, targets, key performance indicators, flashy slogans and even celebrity endorsements - many of these changes tended to put profit before people.
‘‘It’s happening across the world, not just New Zealand.
‘‘Fully funded public systems are under pressure.
‘‘If you look at the NHS [National Health Service] in the United Kingdom or the health system in Australia, it’s all the same.’’
Some of the changes were genuinely helpful, but the ‘‘trade-off’’ was relationships with members of the community and the continuity of their care.
The new 12-month prescriptions were adding to the problem.
From February 1, New Zealanders with stable, long-term conditions such as asthma and diabetes will be eligible for 12-month prescriptions, up from the present three-month limit.
While it meant fewer GP visits, lower costs and more convenience, patients not seeing their GP or pharmacist regularly might lose control of their medical conditions, he said.
‘‘For me personally, I take an anti-hypertensive - a tablet for my blood pressure.
‘‘I lost a bit of weight after Christmas and, because of that, my blood pressure’s actually naturally decreased, so my dose of blood pressure medication is too high now.
‘‘I would go for a wee run and I’d be a little bit dizzy.’’
Because he is a medical professional, he knew he needed to reduce his dosage, but many others in the same situation might not.
The problem would usually be discovered by their doctor or pharmacist when they renewed their three-month prescription.
‘‘But on a 12-month script, they may only find out when they end up in an ambulance or accident and emergency.
‘‘It’s putting people at risk.
‘‘And if a person has a heart attack and dies, who’s liable for that?’’
In a worst-case scenario, he said the health system could decay to a point where it was not functional any more, or patients would just start dying because they were not being seen enough.
‘‘That’s the greatest fear.
‘‘The only way to ‘un-enshittificate’ our healthcare system is for New Zealand to just look after its healthcare system — we need to fund it appropriately and look after it.
‘‘The whole health budget and decision-making needs to be ring-fenced so it doesn’t change every three years.’’
