@jb

I can see the cause for your confusion. That graph is not for all health spending. It is for health spending on public health and prevention, i.e. smoking cessation etc. We spend more than Germany in this respect, but not on the whole health system including hospitalisation. This is the danger of publishing an extract!

I agree with what you are saying on mistakes and the DHB system tho'. Mistakes drive 20% of our healthcare costs. Our system needs to invest in decent systems that prevent mistakes, like unified patient records. And we need to get the incentives right for professionals to get and keep us healthy.

@ Bart Janssen

I am pretty sure I agree with everything you say, I was just picking up on a relatively minor point. Admin bashing is popular with the Govt at the moment, but as the sole solution to our healthcare problems it is just hollow politicking. The savings from the latest admin reforms will be soaked up by healthcare cost increases within 3 months.

@ dyan

Agree completely with what you are saying. This is where our preventative effort needs to go. We could pay for this by having fewer provincial hospitals, and by caring for the elderly rather than treating them.

@ giovanni

I understand things like grocery and gym vouchers are currently being trialled.

"NZ spends 50% more per head than Germany"

Sorry, but this is wrong.

Germany has a pretty good health system, true. Most of Europe does. But lets get real - they spend a LOT more. They are richer and spend more in every dollar earned. And they are up against the wall to maintain service levels - all of Western Europe will see big changes in the coming decade as their healthcare systems go broke. No silver bullet here folks. NZ system is pretty efficient internationally especially given our low income and dispersed population.

You don't have to introduce agricultural subsidies to subsidise good food. Subsidies can go to the consumer rather than the producer. Although the demand for fresh or frozen unprocessed produce may be boosted - isn' that a good thing? And I am not suggesting that alone will make a difference to obesity. Again there is no silver bullet, like smoking it needs to be hit on many fronts simultaneously.

I also agree with Bart about getting docs involved in prioritisation. This is one of the central messages of the book.

But lets not get into bashing administrators. The best hospitals are where the docs and administrators work together well, that needs good administrators. Docs don't want to run hospitals. Admin spending is actually pretty low in NZ - shown by the paltry amount of money saved by the recently announced 'Horn' reforms which tacked 'out of control' administration - increasing healthcare costs will swallow the admin savings generated within 3 months.

Potential problems could be identified early by having free regular check ups, particularly for those at risk. This doesn't need to be done by GPs. There are even remote electronic systems that can do this now.

What I meant by getting over the nanny state conversation is that we (as an electorate) have already spurned some relatively minor measures to counter obesity. Could you imagine the 'nanny state' backlash if taxing poor quality foods was raised?

Thanks for all the responses, it is very heartening to see the conversation happening.

The obesity and personal responsibility issues seem to have captured the collective imagination. There is much more in the book on obesity which I won't repeat here, but suffice to say that prevention is better than cure here too. Getting primary care to help people manage weight, diet and exercise issues better would be a good start, but as with smoking prevention means a lot more than health care changes. A huge shift will be needed in town planning, education, and ultimately food taxation and regulation to sort this out. Our health system is far more complex than we realise (as has been mentioned our relationships and family play a huge role) which makes change complex. But we could start by growing up and getting over the nanny state conversation.

The other touch issue we need to get used to talking about is where to put our health dollar. The comments on "death squad" - this sort of scaremongering has handicapped US reform. Lets not go down that road here, unless we all want an unlimited health care budget. Life and death decisions happen all the time, the ideas in Health Cheque are about making these decisions a bit more transparent and evidence based. Rather than who shouts the loudest.