KEY POINTS:
It's time for a reality check. In 1998, the New Zealand public hospital waiting list was about 89,000.
Ten years on and after billions of extra dollars invested in the health system, the change to the new "booking system" and numerous attempts at engineering the lists, waiting list numbers are reported to be around 42,000.
Most New Zealanders realise that this is due to the systematic removal of patients from the list than any genuine reduction.
The number of people receiving publicly funded elective surgery has remained more or less static since 2000 - up 5 per cent - while the population has grown 7 per cent.
At the same time, the waiting list for all first specialist assessments, which had soared to 122,000 by January 2006, suddenly fell to 82,000 by the end of that year.
And the number of patients receiving a surgical first specialist assessment each year dropped from 250,000 in 2001 to 242,000 last year.
Where have all these people gone? They are now categorised as being in the care of their GP, and are no longer counted.
Public money alone won't solve the waiting list problem. In the UK, one of Tony Blair's election promises before he came to power in May 1997 was that his Government would cut the number of people on British hospital waiting lists by 100,000 in the life of that parliament.
Despite billions of pounds being invested in the public health system, within a year waiting lists had risen to a record.
Why did this happen? When goods or a service are both free and desired by the public the demand them is insatiable. It is not possible to meet all the needs under a public hospital system without a huge investment in public health infrastructure - and even that may not deliver the expected reductions in waiting time.
Demand will continue to grow because we are getting older and more can be done.
Forty years ago there was no such thing as a cardiac surgery waiting list. Joint replacement surgery and cataract surgery were in their infancy. All this technology has emerged in the past two generations. More will continue to emerge.
While these trends are common to all Western countries, New Zealand is different because of its failure to recognise the important contribution the private sector makes in our health sector, and the lack of incentives for people to take control of their own health.
Few people realise that the private sector does more elective surgery than the public sector. As we approach the general election, it is time for all political parties to realistically address the issue and acknowledge that New Zealand's public health system never has and never will meet all the demands placed on it.
New Zealanders deserve honesty in this debate and the opportunity to plan, knowing what they can and cannot expect.
They can then knowledgeably consider private medical insurance as a necessary household budget item, like house, contents or car insurance.
Some years ago, the Federal Government of Australia made private health insurance more attractive by giving a tax rebate to those investing in it, and regulating its cost over the life of the policy holder.
It is not appropriate to replicate the Australian system in New Zealand, but some incentive for people taking health insurance would be beneficial.
In the late 1980s, about 48 per cent of New Zealanders had private health insurance. This dropped dramatically to as low as 31 per cent a few years ago.
There has been a small increase again recently, but more could be done.
Removing fringe benefit tax from employer contributions to the cost of medical insurance may make a significant difference.
Further, as the premiums payable for private insurance grow for those approaching retirement, it is in the Government's interest to ensure those citizens remain covered by private insurance.
Some form of Government financial support would avoid the burden on the public system and must have a cost benefit.
It could be said that the private hospitals industry has a vested interest in the adoption of such strategies.
But that is not the motive for raising this issue.
The majority of private hospitals in New Zealand are not-for-profit organisations, and all are interested in being able to make a positive contribution to improving the health status of all New Zealanders.
* Michael Woodhouse is president of the New Zealand Private Surgical Hospitals Association.
