A pound of cure: Four years ago, *Tim Langburn was told his kidneys were history.
After a 27-year battle with diabetes, he hit rock bottom.
The disease had been eating away his independence and his physical abilities.
Now it would chain him down for daily dialysis.
The financial burden on this former farmer has been just as crushing.
Complications from the illness mean Tim can no longer work, and his wife Sue is now the major breadwinner.
But she frequently has to take unpaid leave from work to be his contact with the outside world when he's in hospital.
Tim says if he had been given more advice and support along the way, things may never have become this bad.
But it's not just Tim and Sue who pay the price for that.
Every New Zealand worker pays, because one in three hospital beds occupied by someone who need not have got that sick is funded by the taxpayer.
And the cost to us as taxpayers is even greater because people like Tim Langburn cannot work or produce to their full potential.
In 2005, for instance, the tangible health costs of smoking to New Zealand were close to $2 billion - more than 1% of our GDP.
This figure included lost production due to smoking-related illness and premature death, and the costs related to treating people with smoking-related illnesses.
An ounce of prevention: There are many ways to change the health sector to save money: the elderly are the latest to have services cut by the Southern District Health Board.
But no amount of health services cuts will be as effective as investing in programmes that stop people getting ill in the first place, keeping them out of hospital.
During 2006-07, the Ministry of Health spent $160 million on such programmes.
That sounds a lot until you hear from Diabetes New Zealand that in the same year it cost almost twice that - $311 million - just to treat hospital patients with diabetes.
An example of investing in a programme to prevent people getting ill is the home-insulation subsidy scheme.
That arose partially from research finding insulated, warmer houses led to less sickness, doctors visits, days off work and hospital time.
Overall, the Otago University researchers found that, for every $1 spent on insulation, a $2 healthcare savings benefit was made.
And that says nothing about the improved quality of life for someone returning each night to a warm, dry home instead of a cold, draughty one rank with mildew.
Government intervention to improve New Zealanders' overall health is also needed.
Often maligned as "nannying", it is actually about giving people a better quality of life and saving taxpayers' money.
Government intervention includes immunisation, breast and cervical screening, promotion of safer sex messages, SunSmart messages, healthy eating and physical activity programmes, and quit-smoking programmes.
Primary care practitioners at the local GP clinic help by identifying and managing easily treated conditions so they do not turn into major hospital dramas.
Examples include vaccinations, early recognition of melanoma and effective control of diabetes.
Some practices are better than others at checking patients for things in addition to the reason for their visit.
They test the blood pressure and cholesterol of people over 40.
They keep an active eye on people with diabetes.
They send out reminders for cervical smears.
There is still room to improve prevention in primary care, thereby keeping people out of hospital.
More focus on prevention makes much more sense than building bigger hospitals.
It contributes to a better quality of life for hundreds of thousands of New Zealanders, and saves precious funding that could be spent elsewhere.
The money people certainly seem to agree.
In 2008, accountancy firm PriceWaterhouseCoopers updated its assessment of the savings achieved if the Government introduced more active diabetes-prevention programmes.
That led Diabetes New Zealand president Mike Smith to say: "It's our contention that if extra spending was undertaken on prevention now, there would be a return of at least four times as much in reduced costs, such as hospitalisation, in 2022.
The benefit could be a lot higher than that, perhaps up to 10 times."
In 2004, the British banker Derek Wanless wrote in a United Kingdom Treasury-sponsored report that the only effective way to tackle the ever-rising cost of healthcare was for the whole of society to engage fully with prevention.
There's no reason to believe it would be different here.
And last year, economist Gareth Morgan wrote: "I accept that we need to treat obesity as we have dealt with smoking. This may mean being a bit of a nanny state, in order to avoid becoming a nursery state."
An ounce of prevention is worth a pound of cure.
Money and more resources will be saved by strengthening the proverbial fence at the top of cliff so we need fewer hospital beds at the bottom.
*Names are changed.
Richard Egan is the Dunedin-based national president of the Public Health Association.
