We Need to Shift the Focus of Health Care

The report released last week showing that more than half a million New Zealanders cannot afford to see their GPs, and that the underfunding of the doctors themselves threatens a shortfall in the numbers of GPs we need, will have alarmed many – and not just those unfortunate families who are denied adequate primary health care.

It will come as a shock to many Kiwis, accustomed as we are to leading the world in so many measurements of social provision, to learn that the primary health care we provide is among the worst in the developed world and that the major reason for that is inadequate funding.

The report is in stark contrast to the government’s claims that the health care available to Kiwis is up to top international standards.  How to explain this disparity between claim and reality?

The answer is that the government chooses to measure things that tell a comparatively good story and to ignore other elements of health care that do not appear in such a good light.

The consequence is that the government focuses on hospital, or secondary care, where operations in the operating theatre can be easily counted, and a successful, or any, operation will earn immediate brownie points.  What the government fails to recognise, however, is that most cases requiring surgery will arise because of an earlier failure to detect or treat – and detecting and treating at an early stage is the domain of primary care.

If we can get primary care right, then the number of operations will decline, and everyone can congratulate themselves.  The need for a high number of surgical interventions and hospital treatments, on this reasoning, is not so much a matter for congratulation as evidence of a failure of primary care, and that is why the report on the deficiencies of primary care is so worrying.

What matters, in other words, in a properly functioning health care system, is that we understand the processes that lead to serious ill-health and that we intervene early enough to prevent those processes from reaching their later and more serious stages.  Saving money at the primary care stage is always going to be a false economy.

We know, for example, that poor diet is likely to lead to obesity and diabetes, that damp housing conditions will lead to asthma and even more seriously to strep throat, rheumatic fever and heart disease, that smoking will cause lung cancer, strokes and heart attacks, that skin lesions and sunburns can lead to melanomas.  We will have a better chance of dealing with all of these serious conditions if we get to them soon enough.

We need to take an overall view of health issues, focusing not just on the operating table but recognising that other agencies – in housing, social services and education, for example, are also involved, and that the first port of call, the family doctor, is the most important.

We are already doing pretty well with some of these issues.  The anti-smoking campaign, for example, the immunisation of new-borns and tiny tots, the screening for heart disease, mammograms to detect breast cancer, are all instances of how we can intervene early and prevent later health troubles.

But we can and should do more, in the knowledge that every dollar spent early can save hundreds of dollars later and, more importantly, can save lives and prevent suffering.  That is why we should all be concerned if the essential service provided by our family doctors is either not available because it is non-existent, or is out of reach because it is too expensive.

And we need to be aware of those important health issues that are not susceptible to cure by surgery – such as mental and sexual health problems, and drug addiction, all of which can destroy lives and tear families apart.  Again, it is the family doctor who is the gatekeeper to the treatment that is essential to deal with these problems.

It is time for the government to re-think and re-focus its efforts – not to scale down the help available in our hospitals but to reduce the demands made on it.  New Zealand should not be languishing in an area where we have traditionally done so well, and where we can and must do again.

Bryan Gould

5 March 2017