The NZ Herald has a good editorial this morning about the level of bureaucracy in New Zealand's health (and probably other) systems, that led to the resignation of Auckland DHB CEO Dwayne Crombie. He was frustrated with the level of reporting, auditing, compliance, and monitoring, which had pretty much become an industry in itself, and probably did not help improve patient outcomes.finereader 6 pro sn
But the Herald gets it bang on when they say:finereader 6 pro sn
This is called accountability in the public sector. Mr Crombie, like many before him, is moving happily to the private sector where accountability is much more straightforward, even in healthcare. If a private hospital or rest home has a healthy balance sheet, it has probably provided a satisfactory service, especially if alternatives were available to its patients or residents.
But those are tests of profitability and competition - profane terms to upholders of so-called public service principles. Having decided that money cannot be the measure of quality and access, they have had to devise written measures. These usually take the form of statements of goals and objectives, each with regular reporting requirements.
That is the advantage that the market has over the public sector. Poor performers either improve or go out of business. They have to also provide value for money, or go out of business. The public sector has no such goals - their budgets continue to increase, with little discernable improvements to patient outcomes. Probably a significant amount of this additional funding simply goes on feeding the bureaucracy, either at the Ministry in Wellington, or in the DHBs to ensure compliance with the Ministry.
That's partially why I favour much more involvement from the private sector in healthcare. I am not saying that we should go down the American route where you need health insurance or you're in trouble - I do favour public funding of health to a significant degree. However, just because it is publicly funded, why do the services need to be provided by a public provider?finereader 6 pro sn
These two can be kept separate. Public money can fund operations at private hospitals. This already happens on a very limited scale - it should be ramped up.finereader 6 pro sn
There are many who complain that this is wrong, as then people are making profits out of healthcare - in the public sector those profits can be fed back into health.finereader 6 pro sn
The problem is that the public sector gets notoriously inefficient. There is no incentive to innovate and be more efficient. The private sector has exactly the incentives we need to improve our health system - we need to burn some of the bureaucracy, and bring in the private sector to a much larger degree if we want to see improvements.finereader 6 pro sn
Otherwise health funding will just continue to escalate with no significant benefits.finereader 6 pro sn
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