I am intrigued. In a time of fiscal constraint, when health boards are being told to reign in their extravagant lifestyles, New Zealand Doctor (4 November) reported that a Roxburgh GP would be prepared to invest in equipment himself to provide flexible sigmoidoscopy, the machinery for which the price is reported to be $150,000 and which is described as a low cost cancer screening procedure.

In its annual accounts the most recent and expensive pieces of equipment bought by the Roxburgh District Medical Services Trust Board are a new ECG machine at $4063 and a $3096 vital signs monitor.

In a DHB, $150,000 capital expenditure usually needs a business case to be made, presented to the board and cheaper options to be discussed especially given that a well prepared patient can be reasonably well serviced by the much more low cost rigid sigmoidoscopy at a total equipment cost of around $1000 for a light source and handle and $20 for the disposable sigmoidoscopes.

The Roxburgh board did spend $9000 on board honoraria in 2008.

In another trust’s accounts, those of Otaihape Health Ltd, which had revenues of $2.55 million for its general practice and hospital services, governance costs were stated as a considerably larger $184,317, although it also made a surplus of $159,641 for 2008.

The Winton Medical Services Trust had income of $1.4 million and ended up with a net surplus of $365,000 to put towards its consolidated fund.

These few examples and the many other trusts that report to the Charities Commission would appear to suggest that there is actually some money to be made in community practice in New Zealand in the 21st century provided the funding is right.

The New Zealand Listener (14 November 2009) highlights a new book by economist Gareth Morgan on the New Zealand health service in which he is reported to take a hard look at what New Zealand can afford and what New Zealanders expect.

For example, he reckons the evidence suggests New Zealand should have 12 hospital emergency departments not the present 35 it apparently has.

An economist’s view is perhaps not “more convenient, better, sooner.”

Morgan also argues that health professionals prefer to work in bigger teams and that many of the non viable provincial hospitals should be closed down. He says that most of the increased costs in health since 2001/02 have gone on wages.

The accounts of the various trusts would concur with that appraisal, but from a GP who went through the financial quagmire of the nineties, GP salaries needed to increase considerably to reverse the destructive effects of the policies of the 1980s and 1990s from the imposition of GST and the debacle of the maternity services post 1990 through the massive hikes in RMO incomes with the destabilisation in the medical workforce that that produced.

Looking at the type of equipment most practices seem to have, several items strike me as more cost effective and useful than the flexible sigmoidoscopy equipment mentioned above.

Top of the list would be the portable ultrasound machine which last week alone could have been used 10 or 20 times in my practice.

Also up there would be dermoscopy equipment and probably some sort of electro cautery or radiofrequency machine since this could rapidly provide a return on its initial investment cost with the high incidence of skin damage in New Zealand.

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