"Better, Sooner, more convenient"..................But for whom?

Welcome to Medtral New Zealand. We are a Medical Tourism company specially set up by New Zealand physicians to provide people living in other countries with access to world-class surgery and aftercare in some of New Zealand’s leading private hospitals.

These high quality non acute medical procedures are available for significantly less than what they would cost in other developed countries such as the USA and Western Europe.

At Medtral New Zealand, we’re committed to ensuring the whole Medical Tourism process is as smooth and stress-free as possible. We handle everything for you, so you can focus all your energy on getting better.

Before your operation and while you are recuperating, you have the opportunity to enjoy some of the many pleasures New Zealand has to offer the international medical tourist

"Better, sooner, more convenient?"

That's the current National Party inspired catch phrase for improvement in the health sector. I heard it from the health minister Tony Ryall when he spoke in March at the rural GP conference in Christchurch. I see it as the title of the annual report of the Pinnacle General Practice Network, a PHO on the North Island. I see it frequently in the newspapers. But I still have to ask myself, why is the well orchestrated drumbeat of the slogan so pervasive? The simple answer is politics, but it probably also strikes a resonant chord with citizens and practitioners alike. The truth is that in New Zealand as with any other health system things are not perfect and the goals identified in the slogan are hard to argue with if they're pursued intelligently, honestly, and equitably.

But as you can see by the small blurb that starts this post, there's competition for health resources in New Zealand. The very first entry to my blog was a half facetious reference to my then upcoming roving locum experience as a new kind of medical tourism. Little did I know that the more questionable form of medical tourism had already taken root right here in New Zealand. Of course, the unapologetic entrepreneur would say "so what?". But I would argue that resources are indeed finite, particularly in a small country. And then there is the previously discussed issue of whether health care can even be regarded as a commodity.

What inspired me to reflect on this was the fact that today I had to write my first patient appeal letter to the departmental review boards who try to assign these scarce resources on a priority basis to patients in the public sector who need "elective surgery". This appeal involved an extremely robust dairy farmer who has now been waiting almost a year for replacement of a hip that has rendered him virtually unable to walk due to severe pain (in spite of attempts to control it medically, I might add). When I see for-profit businesses like Medtral, I'm reminded again that "money talks and nobody walks" (or in this case, you could say money talks or nobody walks...)

It's no coincidence that these sorts of entrepreneurial medical activities are occurring in New Zealand. For the past several years the new government has been quietly pushing its agenda to privatize components of the health sector and to encourage the purchase of private health insurance to gain access to expedited private services. Despite the sensible goals of the slogan, the cynic could be forgiven for pointing out the perverse political incentive to keep the public sector on the ropes. The longer people have to wait, the more attractive the "private option" looks.

All this from a government that just recently embraced a budget based on tax cuts and the increase of the GST, or consumption tax. Aside from being increasingly regressive-- the National Party could not even concede that a consumption tax on food is patently unfair -- this budget resurrects the historically discredited idea that tax cuts for the wealthy will somehow miraculously benefit all. In the words of Bryan Gould, a former vice chancellor of Waikato University, writing in the New Zealand Herald yesterday, "The evidence suggests that if the spending power of the wealthy is increased, it does not "trickle down" to the rest of us through greater investment and a keener eye for new opportunities, but manifests itself instead and more ostentatious and unproductive consumption."

Things like joint replacements for wealthy foreigners, while New Zealand taxpayers languish in pain.

I am not as unworldly as someone might conclude by reading the foregoing. I fully understand that the wealthy will demand and create goods and services that are far out of reach of real world people. The Saudi royal family will continue to fly from the Persian Gulf to the Mayo Clinic in MInnesota. Britain with its National Health Service will still have Harley Street, and the elite of Boston will continue to have a Harvard trained subspecialist for every organ system, the cost or practicality be damned. But in countries that are ostensibly democratic, there still needs to be a public conversation about the allocation of health resources and just how these resources are to be put to use.

For instance, Medtral touts the fact that New Zealand is "first world" and "English-speaking". Elsewhere on their website there is even talk about international awards received by New Zealand for being a peaceful place and having very low crime rates.

All these are attributes of a functioning of civil society, not some entrepreneurial endeavor. It is one thing to be proud of these social achievements but it's another to be benefiting from them while the citizens whose taxes and good behavior are the source of this state of affairs--the source of this positive social capital-- receive increasingly rationed care as a result of a politically and ideologically driven push towards increased privatization.

So no, things aren't perfect in New Zealand, but I still think egalitarian cultural traditions, a history of social cohesion, and a robust democratic tradition will allow the people here to address faults and shortcomings in a constructive manner and not be fooled by Reaganesque sabotage of functioning public institutions in favor of market-based illusions that benefit only the elite minority.