Albert Einstein is often credited with stating that the definition of insanity is doing the same thing over and over again and expecting a different outcome. As with all of these inspirational quotes, Einstein may never have uttered those words, but nonetheless, they have become embedded in popular culture and we drag them out when we need something Einsteinian that we can actually understand. (As opposed to, you know E=MC², which few people actually understand.)
I’ve been thinking about Einstein and his alleged quote of late, especially in the context of the recently announced health sector reforms. The health sector is, in my view, a perfect example of doing the same thing over and over again and being surprised that the result doesn’t change.
I’ve always had a bit of an interest in the health sector. My father was a doctor and like many (most?) children of Jewish doctors, the expectation was always that I would follow in his footsteps and study medicine. The fact that I dropped out of high school and learned a trade didn’t reduce the chip I had on my shoulder about not studying medicine.
Possibly to appease my mother or other familial expectations, I ended up becoming a paramedic for a time and, more recently, became involved in governance in the health sector. I currently sit on the board of Pegasus Health, one of the largest Primary Health Organizations in the country. While the sector reforms will undoubtedly impact upon Pegasus, these thoughts are entirely from my perspective as an interested observer and don’t indicate the views of Pegasus one way or the other.
That significant disclosure said, the fact of the matter is that the health sector is, at its core, every country’s biggest and most intractable problem. Every year new procedures and drugs come to market, generally with hefty price tags. While this is awesome for big pharma which makes trillions of dollars return on its investment, it is terrible for health systems globally which have an essentially limitless demand for resources.
At a human level, it is utterly understandable that people should expect their health system to offer whatever treatment or procedure that they need. However on a macro level, and with constrained resources, that becomes difficult.
Clearly, some of these problems are impossible to remedy, and the changes announced last week won’t impact upon that. However, the changes will, in my personal view, impact upon two problems in the health sector: siloed clinical care and duplication.
Currently, the 20 District Health Boards around the country have their own IT systems and back-office systems and processes. This means that 20 payroll team process pay for staff in 20 different ways and with 20 different systems. It also means that 20 different teams manage building maintenance, service contracting and all the other complexity that is involved in a large sector such as health.
The second area, and one which more directly impacts upon clinical outcomes, is the siloed nature of health data. Currently, there is no overarching system to ensure consistent health data exists across the country let alone one that provides for an individual to gain visibility over their own health records. In the aftermath of the Christchurch earthquakes a decade ago, this kind of data sharing platform was created, as a matter of urgent necessity, but that sort of paradigm doesn’t exist across the country. With luck (and good management) a single organisation will ensure that single platforms cover the entirety of the health system.
And this is a good segue into what I believe could be the most impactful change that the new system could enable. Currently, the health system is all about GPs and hospitals but, despite some posturing, doesn’t really embrace the totality of health at the grassroots let alone the upstream determinants of health outcomes – things like housing, employment and lifestyle factors.
There is no end of money that can be spent on patients when they get sick, but the real opportunity is to avoid people getting sick in the first place. In a generation’s time, maybe we’ll look back and say that the changes announced in 2021 fundamentally changed health outcomes in the future.
Maybe this will be the point where the health is less about being an ambulance at the bottom of the cliff fixing people when they’re broken and more about ensuring that all New Zealanders enjoy good health and wellness, physically and mentally. That’s a formula that Einstein would, I’m sure, appreciate.
