There is also the problem of ideological capture. The New Zealand public health bureaucracy does not attract its fair share of capitalists. It is a haven of socialists. After the election of a left leaning government in 1999, the health system was overhauled. One of the innovations this brought was the near total abandonment of accounting systems. Cost and revenue statistics simply stopped being properly collected and processed, and senior managers in hospitals simply did not know what operations were costing. It would literally be the case that it was only at year end that hospitals would only then find out if they had made budget or not – and generally there were huge blowouts and occasionally resulted in health boards being sacked but usually in the government funding the shortfall. Moral hazzard, anyone?

Why were accounting systems substantially curtailed as a matter of policy? Because it was felt, as it was explained to me by a researcher who led a large study on the health system, that accounting was a tool of business, and business has no place in the provision of healthcare. I kid you not.

Part 1: Coyote, missing from your discussion is non-price rationing, i.e. queuing. There is a half way house that governments exploit mercilessly in nationalised systems, which is to fund most procedures, but require you to wait years to get treatment. This is a clever trick – it shifts costs onto the sick and dying where they are harder to see, but still allows governments to say they care enough to provide the procedure.

Coyote, missing from your discussion is non-price rationing, i.e. queuing. There is a half way house that governments exploit mercilessly in nationalised systems, which is to fund most procedures, but require you to wait years to get treatment. This is a clever trick – it shifts costs onto the sick and dying where they are harder to see, but still allows governments to say they care enough to provide the procedure.

And governments are extremely clever with the numbers. New Zealand instituted a policy whereby nobody has to wait longer than 6 months in a queue. The government here then did one of two things. One is, after six months you will see a general practioner, not a specialist, and then go to the back of the queue again. Or, in extreme cases, you would wait six months in the queue and then cancel your appointment. You would have to start again. Policy met – nobody queued for six months. It could take 2 years to get a hip replacement. Hard to measure the tremendous costs that imposes on the patient who is waiting a significant fraction of their remaining life to be made well again. Political problem solved.

There is also the problem of ideological capture. The New Zealand public health bureaucracy does not attract its fair share of capitalists. It is a haven of socialists. After the election of a left leaning government in 1999, the health system was overhauled. One of the innovations this brought was the near total abandonment of accounting systems. Cost and revenue statistics simply stopped being properly collected and processed, and senior managers in hospitals simply did not know what operations were costing. It would literally be the case that it was only at year end that hospitals would only then find out if they had made budget or not – and generally there were huge blowouts and occasionally resulted in health boards being sacked but usually in the government funding the shortfall. Moral hazzard, anyone?

Why were accounting systems substantially curtailed as a matter of policy? Because it was felt, as it was explained to me by a researcher who led a large study on the health system, that accounting was a tool of business, and business has no place in the provision of healthcare. I kid you not.

Coyote, missing from your discussion is non-price rationing, i.e. queuing. There is a half way house that governments exploit mercilessly in nationalised systems, which is to fund most procedures, but require you to wait years to get treatment. This is a clever trick – it shifts costs onto the sick and dying where they are harder to see, but still allows governments to say they care enough to provide the procedure.

And governments are extremely clever with the numbers. New Zealand instituted a policy whereby nobody has to wait longer than 6 months in a queue. The government here then did one of two things. One is, after six months you will see a general practioner, not a specialist, and then go to the back of the queue again. Or, in extreme cases, you would wait six months in the queue and then cancel your appointment. You would have to start again. Policy met – nobody queued for six months. It could take 2 years to get a hip replacement. Hard to measure the tremendous costs that imposes on the patient who is waiting a significant fraction of their remaining life to be made well again. Political problem solved.

There is also the problem of ideological capture. The New Zealand public health bureaucracy does not attract its fair share of capitalists. It is a haven of socialists. After the election of a left leaning government in 1999, the health system was overhauled. One of the innovations this brought was the near total abandonment of accounting systems. Cost and revenue statistics simply stopped being properly collected and processed, and senior managers in hospitals simply did not know what operations were costing. It would literally be the case that it was only at year end that hospitals would only then find out if they had made budget or not – and generally there were huge blowouts and occasionally resulted in health boards being sacked but usually in the government funding the shortfall. Moral hazzard, anyone?

Why were accounting systems substantially curtailed as a matter of policy? Because it was felt, as it was explained to me by a researcher who led a large study on the health system, that accounting was a tool of business, and business has no place in the provision of healthcare. I kid you not.