Our Health System in the Age of COVID-19

Updated: Jan 23

Victor Luca, 28-Sep-20.

Published, The Beacon, 9-Oct-20.

I have always been exceedingly grateful that we have in our country an ostensibly public health system that we initially modeled on that of England. The system purports to cater for everyone irrespective of means, race, ethnicity or religion. But does it really?

If COVID-19 had been a one-off, black-swan event, then we could be forgiven for being got caught with our pants down. However, it was not! Human society has experienced pandemics of infectious diseases since we first started to domesticate animals more than 10,000 years ago and these pandemics have been coming with increasing frequency as the human population increases.

Health science experts and institutions have been clamoring over the appearance of a major pandemic for decades. The Spanish flu of 1918 should have taught us a lesson, while in recent times, we have had many practice runs with Ebola, SARS, MERS and other infectious diseases. The signs simply could not have been clearer. And still, we were caught woefully unprepared. So unprepared were we that in the first four months of the COVID-19 pandemic our Ministry of Health (MoH) was vigorously telling the population that the virus was not spread via airborne transmission and face masks were not necessary. This was despite the preponderance of scientific evidence to the contrary. In reference to face mask use our health people claimed that “they might do more harm than good”. Presumably, we weren’t told the truth in an attempt to avoid a run on face masks and proper public safety measures being put in place.

So far we have managed by a combination of good luck and good management to somehow scrape through COVID-19 relatively unscathed. Being the most geographically isolated developed nation on earth was a major advantage. Having largely achieved COVID-19 elimination, we should try to stay that way until a vaccine arrives. We should also ensure that we are properly prepared for the next pandemic that will undoubtedly come. What we should have learned a long time ago is that pandemics are not just costly in terms of human lives lost prematurely, but also in terms of the destruction of livelihoods.

We should also have learned that a dose of prevention is better than cure, but we did not. We need to be better prepared, and if it costs a little more to do this, then we should spend the money proactively.

Unfortunately, it seems to me that our health system is falling prey to the ravenous and wanton modus operandi of the medical-industrial complex and neoliberal economics that has taken hold of our society in the past 40 years, and from which, our health system has not been spared.

One measure of the health of a health system is the number of available beds in hospitals per 100,000 of population. It turns out that in terms of this metric we are one of the worst performers in the OECD. In 2019 we had only 2.8 hospital beds available for every 100,000 population.

Hospital beds per 100,000 people for OECD countries in 2019. Source: https://data.oecd.org/healtheqt/hospital-beds.htm#indicator-chart

However, pressure on the availability of hospital beds was not always like this. Below is a graph of the evolution of hospital bed numbers over time in New Zealand. One can see that back in the sixties we used to have nearly 12 beds per 100,000 people. This is more than four times the number of beds per 100,000 of population as we have today, or about where Japan is in 2019. You can see that the numbers started their first step decline after the implementation of the Rogernomics program of economic reforms back in the late eighties.

It was reported in The Whakatāne Beacon as recently as Wednesday 12-August-20 in an article entitled “Hospitals ‘Full to Capacity’”, that there were no hospital beds available in either Whakatāne or Tauranga. Imagine what would have happened had there been demand from COVID-19 patients.

Number of beds per 100,000 of population over time. Source: https://tradingeconomics.com/new-zealand/hospital-beds-per-1-000-people-wb-data.html

Other measures of the health of our healthcare system would be the number of doctors and other medical staff per unit of population, the availability of medical diagnostic (pathology & radiology) and therapeutic medical services and the stocks of equipment.

Regarding equipment, and having many years ago been a practitioner of magnetic resonance for chemical applications, I have a particular interest in Magnetic Resonance Imaging (MRI). This is a tremendously powerful diagnostic technique whose scope and applications keep growing. I have discovered to my surprise that MRI and other radiology services in New Zealand are essentially completely privatized. Some of these companies are in the hands of private equity interests.

The data suggests that New Zealand’s medical system is now estimated to be about 23% privatized. You have to ask yourself who benefits most from this two-tier hybrid public- private system? It is most certainly not those citizens with limited capacity to pay. And despite this push to privatize, waiting times for the uninsured are increasing.

The bottom line is that this privatization by stealth results in an increasingly inequitable system where those with the money to pay get the premium service, and the rest get the waiting list. The reforms of the eighties unleashed the monster and now there is no stopping it from devouring our health system.

It would be devastating for the majority of New Zealanders if our currently hybrid (public-private) system slowly becomes more like that of the United States which has the poorest outcomes and highest costs in the OECD as shown in the graph.

OECD 2010, “Health care systems: Getting more value for money”, OECD Economics Department Policy Notes, No. 2. https://www.oecd.org/eco/growth/46508904.pdf

Our copy-cat, brainless and selfish progression toward a private and elitist healthcare system is now well on its way after four decades of neoliberalism. Already in New Zealand 30% of the privileged in our society have private health insurance. If we copy the United States then we should not be surprised if we end up where they are; with one of the crappiest and costliest healthcare systems in the developed world. We will end up with a system that discriminates against those at the bottom of the socio-economic ladder. In America it is the African-Americans and Hispanics. Here it will be Maori.

What has happened is that we are boiling the frog slowly so that the frog doesn’t notice that it is being cooked to death. We wax lyrical in our country about the four well beings including economic, environmental, social and cultural that we talk so much about and are included in the local government act. How is it, that health and education, being fundamental to well being, are not included? They are both part of the United Nation’s 12 development goals.

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