Monday, July 25, 2016

Managing to the target

National has campaigned hard on healthcare, setting targets for waiting times for elective surgery and fining DHBs which fail to meet them. Now this has had the entirely predictable response: DHBs are managing to the target by keeping patients on secret waiting lists:

District Health Boards struggling to meet the government's goal of a four month waiting time for treatment are being accused of hiding patients on "phantom" waiting lists.

But the government said there were no "virtual" waiting lists in the health system.

The claim comes as latest DHB figures show 45,000 patients sent to a hospital specialist were turned away in 2015 - 3000 more than the previous 12 months.


"Because we haven't got the workforce capacity to actually deliver on that in our public hospitals, there's quite a bit of - I'll use this term loosely - rorting going on, where some patients are actually put on what they call a virtual list or a suspended list. It's like picking up a number of patient files and just putting them on a shelf somewhere," he said.

The government denies that this is happening, of course, but they would. Meanwhile the stats indicate that it is, as do numerous health professionals. And I'll believe them over a health minister with a strong incentive to lie any day.

This was an entirely predictable outcome. In theory, the NeoLiberal public management method of targets and incentives encourages agencies to meet those targets. In practice, it is almost always easier to game the system than meet the target honestly. And so we see Serco directing employment assistance to those who don't need it, and UK emergency departments employing "greeters" so they can tick the box saying that the patient has been seen by someone. The structural logic is the same; why would we expect New Zealand agencies to behave any differently?

The net effect of all of this is to lie to the public about how good the health system is, while continuing to deny them care in practice. That's exactly the sort of dishonesty National was campaigning against when it established targets. But if you're unwilling to spend the money required to ensure that everyone who needs help gets it, lies are all you've got. Personally, though, I'd prefer a properly resourced health system which is there for us when we need it.