The government’s decision to outsource ophthalmology to the private sector has crossed a line.
Health New Zealand Te Whatu Ora are seeking ophthalmology contracts so broad and so prolonged that in 10 years we will have more or less privatised eye medicine in this country.
Moreover, this is happening stealthily. There is no public awareness.
The only clue was on the government’s procurement website where it asked who might be interested in providing ophthalmology services for five years, then another five years, everywhere in the country.
Some scene setting is called for.
Ever since the public health system began in 1938, the private health system has been part of the mix.
The two systems support each other.
Where would the public health system be without GPs or practice nurses working in privately owned medical centres?
Where would a private hospital be without public hospitals to receive the complex cases?
This two-way support is obvious in many other ways too.
The private sector can often be contracted to help the public sector if waiting lists get too long.
On the other hand, the public sector undertakes most of the training of clinicians, no matter whether they end up working in the public sector or the private sector or both.
The relationship between the two is complex. It needs to be managed carefully by both, particularly when hospital care is concerned.
From the private sector perspective, the bottom line matters most.
Helping the public sector trim a waiting list can be a service to society, but shareholders demand it must first make good business sense.
If it doesn’t, it crosses a line.
For public hospitals the key issue is not to make a profit; it is to remain the predominant provider of services.
If it does not, a line is crossed.
As soon as the private sector starts to dominate a clinical service, then that service heads towards privatisation.
That is where eye medicine will now head.
The Minister of Health’s defence is that too many Kiwis are on the waiting list.
He tells us they won’t be too worried if the ophthalmologist who finally gets to see them is working in the private sector or the public sector at the time.
It is free of charge either way because HNZ is paying.
The minister of health is right.
Except for one thing.
If he has found the cash to deal with a large waiting list of eye cases, he could give it to the public sector instead of the private sector.
In other words, the decision to seek bids from the private sector is an ideological decision, dressed up as a minister caring about unmet need.
To be sure there will be devil in the detail.
Likely there will be private sector spare capacity here and there right now.
Likely there will be regions of the country where the public sector lacks the capacity to do much more to address serious waiting lists, even if the minister funded them to work evenings and weekends.
That is precisely why the public sector has for decades sought occasional assistance from the private sector.
What is different about these new contracts is that they cover every region of the country.
For the first time they are also long-term.
They last, not for six or 12 months, but for a decade.
During that time the private sector will lure ophthalmologists from the public sector.
Investors will enlarge their facilities knowing they have a decade to get their money back.
The public sector will quietly wither. It will also reduce training for the future.
Then, 10 years from now, when the private sector is the dominant player in New Zealand eye medicine, the price to HNZ will start to rise.
A privatised health system is always and everywhere more expensive than a public health system.
That is why every developed nation, except the United States, has a predominantly public health system.
So, what should a good minister of health do with the extra money he has found to improve eye medicine in New Zealand? My advice is a bit of everything.
Pinpoint towns or regions where the private sector can help, now and sign time limited contracts so they can get on with the job.
Invest in the public sector in the short term — say recruiting offshore specialists — and in the longer term such as by building new outpatient facilities.
Identify future public sector workforce requirements and fund training programmes to meet them.
It need not be like this.
There is nothing new or special in the above advice.
But there is no corrosive ideology either.
Our health system needs investment, not ideology.
• Pete Hodgson is a former minister of health and a former chairman of the Southern District Health Board. He is a foundation member of Kaitiaki Hauora — Protecting Public Health.
