Two District Health Boards – Otago and Southland - this week put forth a proposal which could see public hospital patients being given the option of paying for their treatment if it could not be funded through the public health system.

This proposal immediately caused an outcry from both hospital doctors and nurses who fear that it would create ‘two classes of patients in the public health system’ - those that can pay, and those that cannot. They fear that this is the start of the slippery slope which would see low-income families pushed to the bottom of the queue while the wealthy that can afford it pay their way to the front. The notion that someone can pay for ‘public’ healthcare immediately has people jumping to the worst conclusion - that it will be the end of our public healthcare system as we know it, with only the rich being able to afford treatment.

I see this proposal somewhat differently. I see this as an attempt by the DHBs to come up with a solution for a public healthcare system that is failing its citizens. Whether or not this is the right solution needs more investigation, but the fact that the DHBs themselves are proposing fundamental changes to the way they provide healthcare shows that they too believe there is a massive problem with our health system that needs to be addressed.

This kind of idea is the predictable outcome of National’s inability to deal with a broken health system. Over the past decade health spending has increased dramatically with 54 percent of income tax spent on healthcare. Just two years ago it was 41 percent. Despite this dramatic increase we have not seen any real improvement in health outcomes for New Zealanders.

National’s solution to this ballooning expense has been to reduce the annual increase of Government spending in healthcare. Inevitably, this approach will result in shortages. In fact this is exactly what Otago and Southland DHB are trying to address with their proposal that has caused such an outcry. Although it is good that National has realised New Zealanders cannot afford to support such increases in health spending at the rate that Labour was, if they fail to reform the system while also starving it of funds, problems will continue to emerge.

The truth is there are already two classes of patients in New Zealand; those that can afford private health insurance, and those that cannot. The first have the choice to use either private or public health care, without the worry of waiting lists. The latter rely solely on our overworked, underperforming health care sector and can languish on waiting lists while their medical condition worsens. With a system that is clearly not working, why do we continue to prod around the edges trying to improve it?

When looking to reform the healthcare sector we must look to our end goals first and plan the system around these goals and not the other way around. The goal is simple - quality healthcare available for all regardless of income. The person the healthcare sector must serve is the patient – not the doctors, not the nurses, and not the bureaucrats.

The only thing that gives power to customers is the fact that they have the money, and therefore they have the choice over who to buy from and what to buy. That means that businesses compete against each other to offer the best products at the best price. Until that property exists in healthcare, it will continue to cost too much and deliver too little.