That reform came and went as everyone discovered that the ‘market’ in health was not on a par with selling groceries
The current narrative in primary care regarding ownership goes something like this. Younger GPs don’t want to buy into a practice; what’s more, the spectre of practice ownership is possibly deterring some doctors from becoming GPs. New GPs want work-life balance and they want a good income, but they don’t like the stress of business ownership. In this narrative, GPs facing retirement are struggling to find a buyer for their practices. A corporate owner with money to spend provides a good option, ensuring a return for the practice owner, a salary for the younger GPs and services for their patients.
In the meantime, corporate providers, with their businesses underwritten by government subsidies, will generally do a good job for most of their patients; the majority will be satisfied, especially if they are seeking episodic care. The practice workforce will have to adapt to having less autonomy in their work; some clinical decisions will be mandated from afar, and GPs will be primarily focused on managing chronic care. Perhaps practice staff will appreciate the benefits of collective employment contracts, as seen in the public sector.
After a few Budgets go by, it is likely that the annual capitation increases will taper off. The Government will deem primary care sorted and shift its attention elsewhere.
Looking to woo older voters, it might inject funding into aged care – that is likely to happen before the next election – but steer clear of tinkering with general practice subsidies for the over 85s, let alone the over 65s.
That will be a problem for corporate owners. Talking to the National Business Review on his firm’s purchase of a 23.8 per cent shareholding in Tend, Pencarrow managing partner Jonathan Goldstone says the investor believes there are “positive tailwinds” for the healthcare industry, given the ageing population. Yes, there will be plenty of activity in caring for an ageing population, but it will be costly, and more akin to a strong headwind rather than a revenue windfall.
Will the big networks be big enough to force the Government’s hand on funding, or will they simply negotiate their way out of providing costly services, including in-person services in rural communities, with the emergency department – where available – becoming the backstop? There is a limit to what can be achieved through digital health.
Large providers can’t be faulted for taking advantage of the opportunities presented in a vacuum of health policy. But does it have to be like this? Can retiring GPs not be given other options? Wouldn’t it be safer for the Government if most of its primary care eggs did not end up in a duopoly or even a monopoly basket?
Wouldn’t it be great to have some options for networks of practices in provincial and rural New Zealand to thrive? And what might that option look like? More assistance for trusts and hauora Māori providers? Financial assistance to small clinician-owned networks? Some recognition that the market will not always provide in health.
It is possible to effect a radical change in primary care – it happened 20 years ago with the introduction of the Primary Health Care Strategy. Now, the sector is being left to drift until no options remain but to be sucked into a current driven from beyond the industry, the shareholders and investors of a small number of influential companies, with the best of intentions.