The side effects of health system centralisation

By Julian Wood May 11, 2021

The Government’s radical centralisation of our health care system will solve many of the problems associated with the current DHB system, but these solutions will come with unwanted side effects, reinforcing inequalities already felt by those in the regions.

The changes bring efficiencies, taking a scalpel to DHB boards and bureaucratic duplication and excising regionally-isolated computer systems and IT contracts. Instead, a national computer system will make it possible to follow patients through the health system allowing health professionals to give better treatment options. National centres of excellence for specialist care are likely to be created around the proposed four regional hubs, and as the costs-per-treatment come down more patients can be seen for the same health money. There is much to be lauded here, but it’s not all good news.

But there will also be costs and risks here, borne by those furthest away from our largest hospitals. In the longer term, those in the wider regions could well find themselves worse off. Two examples are rising non-healthcare costs and local skills shortages.

The regional hubs mean that specialists will be focused here, so if you need advanced cancer treatment, for example, it’s mostly likely to be available via the heart of the hubs. A side effect of this model, however, is that non-healthcare costs rise for those who live outside the hubs. Distances and travel times to access care will increase. There will be the need for accommodation in further away places. It will become harder for those travelling to have support networks or loved ones near when they are needed most. While not on the Government’s balance sheet, these costs are real and need to be considered.

Another side effect of centralisation is that access to local specialised care will become more difficult and expensive. Skills shortages will arise in towns and regions that already struggle to recruit medical specialists like radiologists, dentists or even nurses. These places will become an even less attractive as a place to settle. For medical staff, training, upskilling, and opportunities for career advancement also become centralised, and the costs for health care professionals living outside the hubs rises. If you think wait times for radiology or even dentistry are long in your local area already, unfortunately, they are likely going to get worse.

Overall, in health policy in particular, the fact of scarce resources leads tough funding decisions with uncomfortable trade-offs. Yes, centralisation can drive efficiency, and in a small nation there will be some benefits from having a more unified system. But we also need to acknowledge that there costs to reckon with.

Local access to specialised care, ensuring that our regions are an attractive proposition for medical professionals, and preserving the possibility of having family or friends around you in times of need are all important for thriving communities, upholding human dignity and, of course, our health. If these elements are sacrificed on the altar of efficiency, this will be a bitter pill to swallow for generations to come.

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