Survey of pharmacists finds $5 co-payment fee up to $100/year needlessly leading to mental health incidents, diabetes, amputations and strokes; Pharmacists call for it to be dropped permanently
As a nurse it’s important to note that we already have a bonding scheme in place - $2000 per year for three years of service in a difficult to staff areas (mental health, rural).
No one in officialdom is saying how many new nurses are being trained: - is this figure greater than, same as, or less than previous? Being on the inside you may know.
And how does it compare to the number reported as leaving for Australia?
Good thread. When the buyer of real resources is the currency issuer, there is no "financial affordability" question. Any unemployed nurse can always be employed without driving up other prices. In the public sector all nurses can be paid a decent wage, since there is no "tax pay-for" in an MMT system like NZ's. The cost for government is in the macro - moving real resources out of the private sector into the public sector. In this case students out of one education area into nursing, or out of private healthcare into public healthcare. To accomplish such shifts if it bids against the private sector the tax can be used, but the tax should be levied on that particular narrow private healthcare sector, not the general "middle class". That way a much lower tax is needed, since a general tax is too blunt and has all sorts of bad effects. The false psychology of governments is in thinking they need to tax us to get their own currency in order to pay nurses higher wages. That is utterly false knowledge and complete ignorance of the currency system we have today.
OK, so politicians and health journalists do not understand this, so nurses will not be made whole like this yet. But the politicians will continue to fail us if we do not educate and pressure them.
Based on anecdotal evidence (in the main centres at least), the prescription fee is also near-directly responsible for the closure of many small pharmacies, undercut by warehouse chains who have subsidised the fee to capture foot traffic
Addressing the social determinants of health (SDoH) is a fundamental role of population health/public health strategy. Would love to know where our new PH agencies (1 year old) sit on this specific funding issue (and many others). Vote Health 2022 gave 'up to $61.242 million over four years' to establish new agencies/structures (being the Public Health Agency (PHA) within the Ministry of Health and the National Public Health Service (NPHS) within Health New Zealand) in order to: "build additional capacity and capability to .... lead population and public health policy, strategy, regulation, intelligence, surveillance, and monitoring". So, where do any of these organisations, including the Maori Health Authority stand on this debate? As far as I'm aware, the % of the 9.6% funding that actually gets allocated to core PH functions in NZ, ie. directly maintaining wellbeing/preventing ill health and harm as opposed to fixing the disease/damage caused by lack of prevention - remains tiny. Someone will know the stat? This inadequate funding is another way the 'wellbeing budget' doesn't align (yet).
This number of years of leave owed to doctors lacks the context of the number of doctors being talked about - it could be a few owed a lot, or lots owed a little or somewhere in between.
Continuing the public health theme, the National Party press release about the assistance for nurses and midwives included incorrect information about how many nurses have left since 2017. Minister Alesha Verrall provided figures to Shane Reti and included an explanation that the figures included nurses changing positions within our health system. Regardless National claimed the figures were total nurses who had left our health system. But that isn't being reported very widely.
Not the first time National has been, to put it politely, misleading over figures - it has done the same over truancy levels and crime rates for example.
How can we ensure that we are not fed misleading and incorrect claims during the election campaign? Pity we do not have truth in advertising laws.
This is what 40 years of neoliberal user pays economics has delivered, socialised costs on the most vulnerable and privatised profits. The older among us wont be surprised, but will we continue to helplessly despair at the data, or start demanding real change? It seems shameful not to try.
Given the “wealthy” make up such a small % of the population it seems strange a government is ever elected to represent their interests in a democracy? Perhaps it is the large number of voters aspiring to be wealthy which protects them?
Yes, the idea of ever increasing wealth as a personal goal in life is entrenched in the modern capitalist mindset, but the resources of the planet are finite, so it comes as a cost to others. Hence our current extremes of wealth and poverty in the world.
I think that the answer is more fundamental than that Bernard. What about the post-capitalism that is talked about? Plenty of examples but here is one:
I,ve been trying to think of how to demand change. I too despair. Its like 40 years ago many of us saw some trees being planted upside down. It has seriously affected the growth of the trees. . Gallons of data have been collected about the trees. Hundreds of hands been rung. But the people responsible for the trees have a strange deafness and a strange faraway look in their eyes. Can it be that they really dont want to know that they could fix it all by planting the trees up the right way?
Scrapping the fees free first year is the most ridiculous of all the National policies. How many young people won't bother with University but also as importantly, Trade and Vocational tertiary education? We need to be training so many young people in all areas. However, the government must also properly fund Tertiary education which successive governments have progressively not kept up with.
The pharmaceutical $5 co-payment removal, well covered above, is a no-brainer. Many of those experiencing episodes in their journey with schizophrenia are lacking insight into their condition right when they need their medication the most. Transplant patients are so rare in the population it is pretty mad that they are charged for medicines that keep tissue rejection at bay. Diabetics are similar but much more prevalent, however they are essentially lacking a functioning organ - the pancreas. Medicines controlling blood pressure can help to avoid catastrophic "Brain Attack", aka Stroke, which leave many dependent on various degrees of care. Antibiotics can save lives and limbs threatened by bacterial infection. The melancholy need occasional periods on carefully monitored anti-depressants, just to keep them on this earth with us. The kindest thing the Labour Government could do would be to listen to this group of concerned pharmacists. And as you point out Bernard, it makes economic sense down the track to the tune of a lot more than is saved by gouging these citizens.
On a totally different subject, the photo of the world map showing where most of the population live (in East Asia within the small "moon" circle) is a serious warning that NZ must make plans for cross-party agreements on population growth, starting with our closest neighbours, outside "the moon" - those in our shared Pacific ocean whose islands are literally drowning.
That's a policy that needs changing immediately. Talk about cutting off your nose to spite your face. I think we could directly ask the Min of Health Dr Aysesha Verrall to change this. Surely she will get it. Re nurses, I am thinking of the leavers at Waiheke High last year when they were asked what they intended to study. As far as I know, not one of them was heading into a medical career. Also know doctors who actively discouraged their children against going into medicine. I think medicine, nursing, teaching are just really tough career choices. I think we should pay docs, nurses and teachers to train, give them an accommodation allowance or a hostel to live in while they train nearby the hospital. A sort of back to the way it was....
Also thinking of how many doctors Cuba has and trains. Am betting it's free to study there and there must be lots of incentives. Could we recruit a few maybe? How's our diplomatic relations with Cuba? Also wondering how easy it is for overseas docs/nurses to actually live and work here as hear a few rumours that some Brits and Canadians have found it tough getting through the NZ immigration lot.
It sounds like I am keen on Cubas doctors & their trains but am not sure they have any trains or oil at present. I will look up how doctors they are training every year though.
It's almost like National has just found the filing cabinet full of Labour's policies that they threw out last time they were in government.
Bonded Merit Scholarships: From 2006 - The Scholarship will pay $3,000 each year towards course fees for a maximum of four years. Students who receive the Bonded Merit Scholarship will be required to remain in New Zealand for a period of time after they complete their degree. - National kept the scholarship to those that had already been awarded it but removed any requirement to stay in the country (for no obvious reason).
Step Up Scholarship: From 2003 - A bonded scholarship scheme for (surprise surprise) students studying medicine, nursing, veterinary, midwifery, and dentistry. Students receiving a Step Up scholarship will be required to remain and work in New Zealand for up to four years after graduation.
I think your cost-benefit calculations for the prescription charges are a little bit disingenuous, Bernard.
This study intentionally chose the most vulnerable participants (both in terms of health and financial status). Extrapolating those findings out to the whole population is intentionally misleading. That would be like calculating our transport emissions by assuming that every vehicle is a Ford Ranger ;)
I agree with everything else you say, it would be much simpler and fairer to scrap the fees, but I don't think you shouldn't be basing this argument on a fallacious financial extrapolation.
Excellent reporting Bernard. But you need to mention that NZ runs an MMT currency, albeit most politicians and journalists supposedly holding them accountable are ignorant of this fact. So the question of "affordability" of medicines that have already been manufactured and already exist is not a "find the money" problem for government. Government can always make the payments for the pharmacies (natural monopsony), they just use a computer to mark-up the bank account of the supplier. Is this going to be medicine supply price inflation? Not on your life - provided government pays the market price and does not out-bid the private sector for the same resources.
If the medicines do not exist then manufacturing needs to be shifted from other private sectors (vanity healthcare & cosmetics industry suppliers) into the public sector, but the manufacturers can always be private contractors, the government need not own the medicine factories, but can always instead be the monopsony buyer or importer. This is how to get "free" basic healthcare. The cost is not tax-funded, it is a cost to the private sector whose resource capacity is moved into the public sector, but if I am a private contractor, I do not really care where my sales come from, better it is from long-term government contracts with governments who cannot run out of their own fiat currency.
There is always this political choice available for public goods - of nationalising the buyer, not the maker. There is no "tax pay-for" in an MMT system. Any tax needed to shift labour from private healthcare suppliers to public contractors is a choice of government, no middle class tax hike is needed.
It is sickening (pun intended) and shameful NZ politicians are so ignorant of the monetary system that they cannot figure out how to get free but rationed medicines into the lives of people who need them, when the medicines are already available for sale. The rationing is the stabiliser here, not the market price. The politicians simply do not understand MMT (except, to my knowledge, for a couple of Green Pty people I have talked to in private, who are afraid to say publicly they comprehend MMT). All the others think there is a nasty "tax pay-for." There is no such thing. Not if the real resources already exist and are not being employed.
There is a strong possibilty that the estimated savings/stopped loss of 2.65 Billion (from your Feb post) is a significant under estimate. Norris et al don't appear to have taken in to account the reduced productivity that is caused by chronic disease, and in particular poorly controlled chronic disease. There is a treasury working paper by Heather Hood https://www.treasury.govt.nz/sites/default/files/2010-11/twp10-04.pdf tries to quantify this.
Hi team,
As a nurse it’s important to note that we already have a bonding scheme in place - $2000 per year for three years of service in a difficult to staff areas (mental health, rural).
Hi Philip
No one in officialdom is saying how many new nurses are being trained: - is this figure greater than, same as, or less than previous? Being on the inside you may know.
And how does it compare to the number reported as leaving for Australia?
What are your thoughts on this thread?
https://twitter.com/mikeythenurse/status/1652480765454860290?t=ey2n3JddEITc6f2t7dugfA&s=19
Good thread. When the buyer of real resources is the currency issuer, there is no "financial affordability" question. Any unemployed nurse can always be employed without driving up other prices. In the public sector all nurses can be paid a decent wage, since there is no "tax pay-for" in an MMT system like NZ's. The cost for government is in the macro - moving real resources out of the private sector into the public sector. In this case students out of one education area into nursing, or out of private healthcare into public healthcare. To accomplish such shifts if it bids against the private sector the tax can be used, but the tax should be levied on that particular narrow private healthcare sector, not the general "middle class". That way a much lower tax is needed, since a general tax is too blunt and has all sorts of bad effects. The false psychology of governments is in thinking they need to tax us to get their own currency in order to pay nurses higher wages. That is utterly false knowledge and complete ignorance of the currency system we have today.
OK, so politicians and health journalists do not understand this, so nurses will not be made whole like this yet. But the politicians will continue to fail us if we do not educate and pressure them.
Based on anecdotal evidence (in the main centres at least), the prescription fee is also near-directly responsible for the closure of many small pharmacies, undercut by warehouse chains who have subsidised the fee to capture foot traffic
Thanks Tim. Yes. A weird unintended consequence of the existing policy.
the Market decides - not sure it deals with intentions
Hey Bernard do you have a graph on our public health spending and tax compared to the rest of world
We're at about 9.6% of GDP, about one percentage point below Australia and two-three points below UK. US on 19%... Data and charts here https://stats.oecd.org/Index.aspx?DataSetCode=SHA https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2019&locations=NZ&start=2000&view=chart
Addressing the social determinants of health (SDoH) is a fundamental role of population health/public health strategy. Would love to know where our new PH agencies (1 year old) sit on this specific funding issue (and many others). Vote Health 2022 gave 'up to $61.242 million over four years' to establish new agencies/structures (being the Public Health Agency (PHA) within the Ministry of Health and the National Public Health Service (NPHS) within Health New Zealand) in order to: "build additional capacity and capability to .... lead population and public health policy, strategy, regulation, intelligence, surveillance, and monitoring". So, where do any of these organisations, including the Maori Health Authority stand on this debate? As far as I'm aware, the % of the 9.6% funding that actually gets allocated to core PH functions in NZ, ie. directly maintaining wellbeing/preventing ill health and harm as opposed to fixing the disease/damage caused by lack of prevention - remains tiny. Someone will know the stat? This inadequate funding is another way the 'wellbeing budget' doesn't align (yet).
I also wonder if this should get opened up to the public. Medical costs are a key issue
Thanks Renee. Will do at 2pm.
This number of years of leave owed to doctors lacks the context of the number of doctors being talked about - it could be a few owed a lot, or lots owed a little or somewhere in between.
Continuing the public health theme, the National Party press release about the assistance for nurses and midwives included incorrect information about how many nurses have left since 2017. Minister Alesha Verrall provided figures to Shane Reti and included an explanation that the figures included nurses changing positions within our health system. Regardless National claimed the figures were total nurses who had left our health system. But that isn't being reported very widely.
Not the first time National has been, to put it politely, misleading over figures - it has done the same over truancy levels and crime rates for example.
How can we ensure that we are not fed misleading and incorrect claims during the election campaign? Pity we do not have truth in advertising laws.
Thanks Andrew. Saw that and didn't report it to begin with. Plenty of others called it out.
This is what 40 years of neoliberal user pays economics has delivered, socialised costs on the most vulnerable and privatised profits. The older among us wont be surprised, but will we continue to helplessly despair at the data, or start demanding real change? It seems shameful not to try.
Yep. Fair to ask the question. Ultimately, the answer is higher taxes and spending/GDP.
Does that mean that it is really only the wealthy that could convince a govt to raise taxes?
Given the “wealthy” make up such a small % of the population it seems strange a government is ever elected to represent their interests in a democracy? Perhaps it is the large number of voters aspiring to be wealthy which protects them?
Yes, the idea of ever increasing wealth as a personal goal in life is entrenched in the modern capitalist mindset, but the resources of the planet are finite, so it comes as a cost to others. Hence our current extremes of wealth and poverty in the world.
I think that the answer is more fundamental than that Bernard. What about the post-capitalism that is talked about? Plenty of examples but here is one:
https://www.rethinkeconomics.org/journal/postcapitalism/ Its re Paul Mason - a guy sort of like yourself Bernard.
I,ve been trying to think of how to demand change. I too despair. Its like 40 years ago many of us saw some trees being planted upside down. It has seriously affected the growth of the trees. . Gallons of data have been collected about the trees. Hundreds of hands been rung. But the people responsible for the trees have a strange deafness and a strange faraway look in their eyes. Can it be that they really dont want to know that they could fix it all by planting the trees up the right way?
Is there any data as to how many prescriptions aren't being picked up because they come from a specialist which means a $15 prescription cost?
Also worth to note, National said they will scrap the first year fees free. That adds $8000 (aprox) to the debt of nurses.
And not a single word about how to retain the experienced nurses that we rely on to train the new ones.
Scrapping the fees free first year is the most ridiculous of all the National policies. How many young people won't bother with University but also as importantly, Trade and Vocational tertiary education? We need to be training so many young people in all areas. However, the government must also properly fund Tertiary education which successive governments have progressively not kept up with.
The pharmaceutical $5 co-payment removal, well covered above, is a no-brainer. Many of those experiencing episodes in their journey with schizophrenia are lacking insight into their condition right when they need their medication the most. Transplant patients are so rare in the population it is pretty mad that they are charged for medicines that keep tissue rejection at bay. Diabetics are similar but much more prevalent, however they are essentially lacking a functioning organ - the pancreas. Medicines controlling blood pressure can help to avoid catastrophic "Brain Attack", aka Stroke, which leave many dependent on various degrees of care. Antibiotics can save lives and limbs threatened by bacterial infection. The melancholy need occasional periods on carefully monitored anti-depressants, just to keep them on this earth with us. The kindest thing the Labour Government could do would be to listen to this group of concerned pharmacists. And as you point out Bernard, it makes economic sense down the track to the tune of a lot more than is saved by gouging these citizens.
On a totally different subject, the photo of the world map showing where most of the population live (in East Asia within the small "moon" circle) is a serious warning that NZ must make plans for cross-party agreements on population growth, starting with our closest neighbours, outside "the moon" - those in our shared Pacific ocean whose islands are literally drowning.
That's a policy that needs changing immediately. Talk about cutting off your nose to spite your face. I think we could directly ask the Min of Health Dr Aysesha Verrall to change this. Surely she will get it. Re nurses, I am thinking of the leavers at Waiheke High last year when they were asked what they intended to study. As far as I know, not one of them was heading into a medical career. Also know doctors who actively discouraged their children against going into medicine. I think medicine, nursing, teaching are just really tough career choices. I think we should pay docs, nurses and teachers to train, give them an accommodation allowance or a hostel to live in while they train nearby the hospital. A sort of back to the way it was....
Also thinking of how many doctors Cuba has and trains. Am betting it's free to study there and there must be lots of incentives. Could we recruit a few maybe? How's our diplomatic relations with Cuba? Also wondering how easy it is for overseas docs/nurses to actually live and work here as hear a few rumours that some Brits and Canadians have found it tough getting through the NZ immigration lot.
It sounds like I am keen on Cubas doctors & their trains but am not sure they have any trains or oil at present. I will look up how doctors they are training every year though.
ps Bernard I can't get a handle on the signing in requirement. Where is it?
It's almost like National has just found the filing cabinet full of Labour's policies that they threw out last time they were in government.
Bonded Merit Scholarships: From 2006 - The Scholarship will pay $3,000 each year towards course fees for a maximum of four years. Students who receive the Bonded Merit Scholarship will be required to remain in New Zealand for a period of time after they complete their degree. - National kept the scholarship to those that had already been awarded it but removed any requirement to stay in the country (for no obvious reason).
Step Up Scholarship: From 2003 - A bonded scholarship scheme for (surprise surprise) students studying medicine, nursing, veterinary, midwifery, and dentistry. Students receiving a Step Up scholarship will be required to remain and work in New Zealand for up to four years after graduation.
I think your cost-benefit calculations for the prescription charges are a little bit disingenuous, Bernard.
This study intentionally chose the most vulnerable participants (both in terms of health and financial status). Extrapolating those findings out to the whole population is intentionally misleading. That would be like calculating our transport emissions by assuming that every vehicle is a Ford Ranger ;)
I agree with everything else you say, it would be much simpler and fairer to scrap the fees, but I don't think you shouldn't be basing this argument on a fallacious financial extrapolation.
Excellent reporting Bernard. But you need to mention that NZ runs an MMT currency, albeit most politicians and journalists supposedly holding them accountable are ignorant of this fact. So the question of "affordability" of medicines that have already been manufactured and already exist is not a "find the money" problem for government. Government can always make the payments for the pharmacies (natural monopsony), they just use a computer to mark-up the bank account of the supplier. Is this going to be medicine supply price inflation? Not on your life - provided government pays the market price and does not out-bid the private sector for the same resources.
If the medicines do not exist then manufacturing needs to be shifted from other private sectors (vanity healthcare & cosmetics industry suppliers) into the public sector, but the manufacturers can always be private contractors, the government need not own the medicine factories, but can always instead be the monopsony buyer or importer. This is how to get "free" basic healthcare. The cost is not tax-funded, it is a cost to the private sector whose resource capacity is moved into the public sector, but if I am a private contractor, I do not really care where my sales come from, better it is from long-term government contracts with governments who cannot run out of their own fiat currency.
There is always this political choice available for public goods - of nationalising the buyer, not the maker. There is no "tax pay-for" in an MMT system. Any tax needed to shift labour from private healthcare suppliers to public contractors is a choice of government, no middle class tax hike is needed.
It is sickening (pun intended) and shameful NZ politicians are so ignorant of the monetary system that they cannot figure out how to get free but rationed medicines into the lives of people who need them, when the medicines are already available for sale. The rationing is the stabiliser here, not the market price. The politicians simply do not understand MMT (except, to my knowledge, for a couple of Green Pty people I have talked to in private, who are afraid to say publicly they comprehend MMT). All the others think there is a nasty "tax pay-for." There is no such thing. Not if the real resources already exist and are not being employed.
While I realise that Chemist Warehouse is not everywhere in the country I live in Christchurch and they do not charge a prescription fee.
Sorry. It is the Bargain Chemist Tower Junction where I get my prescription from. They don’t charge.
There is a strong possibilty that the estimated savings/stopped loss of 2.65 Billion (from your Feb post) is a significant under estimate. Norris et al don't appear to have taken in to account the reduced productivity that is caused by chronic disease, and in particular poorly controlled chronic disease. There is a treasury working paper by Heather Hood https://www.treasury.govt.nz/sites/default/files/2010-11/twp10-04.pdf tries to quantify this.