The ethics of New Zealand's two-tier health system

Nau mai haere mai – welcome to your newsletter.

No doubt health will be a point of debate in the lead-up to the elections in October, so let’s start by exploring the ethics of New Zealand’s two-tier, public-private system. From an ethical perspective, timely and comprehensive healthcare should be available to everybody – but we all know the reality is sometimes very different.

While most essential health services are free for all, some regions have longer waiting lists, access to primary care and specialists remains unequal and people who can afford to pay for private care are seen and treated faster.

As bioethicist Elizabeth Fenton and health policy expert Robin Gauld write, this public-private approach can only be justified if the services provided in the public system meet patients’ needs “essential to human flourishing”.

But if the public system isn’t adequately resourced to provide sufficient care, private-sector facilities and policies that favour their proliferation deplete the public sector. “We should not be under any illusion that private insurance and private healthcare are altruistic in relieving pressure on the public system. They profit from failures of the public system … and patients’ desperation to receive timely treatment.”

The authors argue that as the gap between services available in the private and public tiers grows, it threatens social cohesion and solidarity. “When the worse-off are required to accept services below reasonable expectations of routine care (and the demonstrable harms that result), individuals are no longer in the same boat.”

As always, you’ll find a lot more to read in this newsletter and on our homepage, including analysis of the roots of some people’s discomfort with bilingual road signs and new research on how earthquakes can change the path of a river.

Finally, we are two weeks into our fundraising campaign and many generous people have made a contribution already. Every little bit helps our not-for-profit newsroom deliver the kind of evidence-based journalism that is our mission to produce. If you can donate to support our work, please click here for more information, but we also truly appreciate the support you give by subscribing and sharing our newsletter – and of course by reading. Until next week, mā te wā.

Veronika Meduna

Science, Health + Environment New Zealand Editor

Today's newsletter supported by The Conversation

The real cost of New Zealand’s two-tier health system: why going private doesn’t relieve pressure on public hospitals

Elizabeth Fenton, University of Otago; Robin Gauld, University of Otago

The argument that private healthcare relieves pressure on the public system is misleading. Private care profits from failures of the public system and patients’ desperation for timely treatment.

Earthquakes can change the course of rivers – with devastating results. We may now be able to predict these threats

Erin McEwan, University of Canterbury

Earthquakes can cause rivers to unexpectedly change course. New research reveals we may be able to predict the resulting flooding – and plan better for future disasters.

Slow down Simeon Brown – bilingual traffic signs aren’t an accident waiting to happen

Richard Shaw, Massey University

Concern over bilingual road signs in New Zealand is as much political as it is about safety – but the international evidence suggests there’s little to worry about.

‘Whose side are you on mate?’ How no one is free from bias – including referees

Tim Dare, University of Auckland; Justine Kingsbury, University of Waikato

Referees would need to be superhuman to be immune to the risk of bias – maybe that’s something all sports fans could agree on.

70 years after the first ascent of Everest, the impact of mass mountaineering must be confronted

Yana Wengel, Hainan University; Adele Doran, Sheffield Hallam University; Michal Apollo, University of Silesia in Katowice

Since Edmund Hillary and Tenzing Norgay conquered Everest/Chomolungma in 1953, commercial mass mountaineering has put unsustainable pressure on unique environments and communities.

Could wildflowers and bug hotels help avert an insect apocalypse? We just don’t know – yet

Rob Cruickshank, University of Canterbury

There’s a lot of enthusiasm for wildflower fields and bug hotels. But before introducing these insect-saving measures, we need to better understand when they help – and when they don’t.

Free public transport is a great start – but young people won’t give NZ governments a free ride on climate change

Kate Prendergast, University of Canterbury; Bronwyn Hayward, University of Canterbury

Budget 2023’s investment in public transport will have far-reaching benefits for the climate and for overall wellbeing. But our study shows young people want much more.

From our foreign editions

Rupert Murdoch: how a 22-year-old ‘zealous Laborite’ turned into a tabloid tsar

Sally Young, The University of Melbourne

Young Rupert took up his inheritance in Adelaide in 1953 with minimal journalistic experience. He quickly revealed himself to be a ruthless rule-breaker and hands on, expansionary proprietor.

Why more foam makes for the best beer-drinking experience – and always has

Anistatia Renard Miller, University of Bristol

If your beer has no foam you could end up with terrible bloat.

‘They just ignored my tears, they ignored my unhappiness’: former Irish nuns reveal accounts of brainwashing and abuse

Karen Hanrahan, University of Brighton

Brainwashed, fearful and abused: convent life worked to erase a sense of individual identity through adherence to strict rules.

Debt ceiling negotiators reach a deal: 5 essential reads about the tentative accord, brinkmanship and the danger of default

Bryan Keogh, The Conversation; Matt Williams, The Conversation

The deal would raise the ceiling for two years, cap some federal spending and impose new work requirements on certain federal benefits. It still needs the blessing of Congress.