Little known impacts of New Zealand’s low population and frugal economy are the restrictions placed on the funding of health care and the inability to recruit and retain staff. It has resulted in dire shortages of trained medical staff and  the over reliance on locums at considerable expense to DHB’s that are often  struggling with massive budget blow-outs. No wonder those immigration medicals are so stringent, New Zealand isn’t a country to become sick in.

Kate Newton in the Dominion Post today writes about a new Government report that confirms that high cost, novel drugs aren’t being made available in New Zealand and some low-cost but highly specialised drugs are difficult to access too.  It appears that New Zealanders are not being given access to  medicines that are available in countries such as Australia, with fatal consequences: (Also read Tocilizumab, Drug to Treat Castleman’s Disease ‘Not Funded in New Zealand’)

“Patients in New Zealand have less access to new, high-cost medicines than comparable countries and the result for some people can be extreme, a Government report has found.

A three-person panel set up by Health Minister Tony Ryall last year has issued its report on high-cost, highly specialised medicines, with 17 recommendations for improving access for patients and doctors.

The panel – GP Paul McCormack, former MP Joy Quigley and economist Paul Hansen – found that, although New Zealand spent less money on drugs than many other countries, drug-buying agency Pharmac was a “world leader” in achieving value.

“Nonetheless … we have been convinced that New Zealand has less access to new, high-cost medicines than other countries, in particular Australia,” the report said.

“At an individual patient level, the impact of not having access to some medicines can be severe. Some patients … pay a high personal price in terms of their poor health in the extreme, resulting in death.”

There were also problems in accessing some low-cost but highly specialised drugs, the report said.

Pharmac is New Zealand’s sole drug-buying agency and uses its power to negotiate bulk-purchasing contracts.

But because of its emphasis on value for money, it does not always immediately fund new drugs.

The panel believed increasing access to low-cost, highly specialised medicines should be relatively easy.

Among other things, it recommended Pharmac include such drugs as “companion” medicines in contracts for larger-volume medicines.

Improving access to high-cost medicines would be more difficult, but there were three options available, the panel said.

These were increasing funding, raising the $3 prescription fee patients pay for funded drugs, and reducing wasteage in the drug-funding system.

The report recommended the third option, suggesting, among other things, that the funding system could be streamlined by combining all pharmaceutical schedules into a single schedule to limit bureaucracy and confusion.

Mr Ryall said he would consider the report alongside another one on expanding Pharmac’s role, which is due to be completed soon.

Changes would be announced toward the end of the year, he said.

The Researched Medicines Institute, which has often criticised Pharmac, said it welcomed the report and would study it in detail.”

Background:

It’s been know for some time that Pharmac doesn’t allow New Zealanders to access new medicines for five to 10 years after they are widely used elsewhere in the world, and then it waits until they are generic until they are widely used. The system keeps prices down for the Government but has been criticised for restricting drug choices and delaying the arrival of some new medicines.

South Island health boards are spending millions of dollars to fly in medical specialists from overseas to cover staff shortfalls. The West Coast District Health Board spent more than $1.3 million over the past financial year employing senior medical staff from overseas. This included more than $130,000 on flights and accommodation. (source)

National’s health spokesman Tony Ryall reckons that spending on locum doctors in hospitals could cost more than $100 million a year and has doubled over the last 3 years. (source) Aside from the obvious costs patients do not receive continuity of care and the doctors are “not culturally aware of the issues.”

50% more Kiwis die of heart attacks each year than in comparable countries. NZ suffers 63 deaths per 100,000. The median for OECD countries is 44.  “New Zealand spends far less on hospital and healthcare per person” according to report by Johns Hopkins University.

“A drug credited with saving lives is facing unacceptable delays for public funding, say a cancer specialist. Mabthera, one of a new generation of smart drugs like Herceptin that targets specific characteristics of cancer cells, is already funded for an aggressive form of lymphoma. But the application for it to be used for follicular lymphoma, which makes up about a third of the 770 lymphoma cases in New Zealand, has languished among drug agency Pharmac’s decision-making processes, said Auckland oncologist Peter Browett. (source)

Every year a limited number of cancer patients are lucky enough to be sent to Australia for treatment link .  in 2007 Sending  people to Australia was intended to  be a temporary solution as staff worked to build capacity at home. “The main issue is the level of expertise, particularly in planning”

Pharmac has just announced that it will at last fund a drug to treat Alzheimer’s – more than a decade after it became available. They waited until until one of the original drugs, containing donepezil, came off patent and a generic version was offered at a greatly reduced price. (source) More than 40,000 people in New Zealand are believed to have dementia. More than half have Alzheimer’s.

“Healthcare system is second rate” – An American nurse’s first hand account of working in New Zealand link:

“– they are resistant to change more so than anywhere I’ve ever seen. I worked in the health insurance industry for 10 years before I came here, and one of the things I looked for were areas where money was wasted. Here, I can see thousands and thousands of health care dollars wasted because there is no incentive to change things. And they do some things here the same way we did them in US hospitals when I was a student nurse. And since residents here see health care as “free”, they really don’t care. And they don’t realize the health care system is second rate. Yep, I said it and I really believe it. I see things every day that scare the hell out of me. People have to wait days for some tests and treatments that would be done in a matter of hours in the US. By then, permanent damage has been done. But, oh well, that’s just the way it is.

The saddest thing is, I believe New Zealand, because it IS a small country, has the potential to be a world leader in health care. Too bad it will never happen, because nothing will change unless there is a catastrophe that makes it absolutely necessary and without option…”

“Nelson nurses tell of ‘horrific workloads” link

“…One nurse, who said she sought counselling after months of stressful shifts, ended up resigning. She said six other nurses had also left their jobs at the ward she worked in since September last year and most were not being replaced.

The woman, who wants to remain anonymous, said she was speaking out because she believed it was important to battle for patient and nurse safety. She believed nurses needed a lawyer to work in their defence because of a lack of action over their concerns from the New Zealand Nurses Organisation and hospital managers. Letters shown to The Nelson Mail outline a detailed complaint she made to senior management, including the director of nursing, last year.  In the letter, the nurse points to a shift last winter which prompted nurses to file an incident form.

It was one of the “many horrific shifts” she had to work. There were four nurses when six should have been on with six admissions, a cardiac arrest and a death. She had no meal break and each nurse had seven to eight patients as well as a student to oversee…

Speaking Out

Former Nelson Hospital nurse: “As nurses we expect the odd busy horrible shift, but this becomes an ethical dilemma when the majority of shifts are like this.”

“Lives have already been put at risk, with deaths occurring.”

“The environment at this hospital is already at crisis point, with staff leaving and patient deaths. How the hell are staff going to cope with cutbacks if the environment has already been so badly affected in the past few years? The winter will be a nightmare from hell.“

Current nurse: “Maternity staff have been leaving in droves over the past 18 months and there has been a policy not to replace them.”