Latest news with #Sapere
RNZ News
2 days ago
- Health
- RNZ News
New medical school at University of Waikato boasts better cost-benefit ratio, case shows
University of Waikato. Photo: Supplied / Google Maps A new medical school at the University of Waikato has been found to have a better cost-benefit ratio than other options, although only slightly. The business case for the new school has been released, which said it would have lower operating costs than other options, and would produce a higher proportion of graduates going on to become GPs. The University of Auckland has raised concerns over some of the business case's assumptions, but the health minister insists the new school was the most effective proposal at building New Zealand's "critical" health workforce. Last week, the government confirmed it would move ahead with the Waikato school, and was confident it presented the best value for money. From 2028, students will be able to start at the four-year graduate entry programme, which is intended to boost the country's rural GP workforce. National had campaigned on establishing the school at the 2023 election, but a [ full cost-benefit analysis was required as a condition of its coalition agreement with ACT. The Ministry of Health dumped a series of documents on Friday evening, including various Cabinet papers and minutes, the cost-benefit analysis conducted by Sapere, and the Ministry's detailed business case. The business case looked at three options: increasing the intake at the existing University of Auckland and University of Otago schools, a joint rural training programme run by the two schools, and the new Waikato school. The first option was estimated to cost $10.9b over the years between 2026 and 2042, and deemed the more expensive option. The joint rural training programme was estimated to cost $10.27b over the same period, while the new school - the cheapest option - was estimated to cost $9.1b. While it had the most expensive capital costs ($236.3m) the new school's operating costs ($361.6m) were deemed to be cheaper than increasing the intake at the existing schools ($513.6m) or the joint rural training programme ($508m). The lower operating costs were due to the Waikato course being shorter, the business case said. Prior degrees were also out of scope of the business case, despite the Waikato course being a graduate-entry programme. Professor Warwick Bagg, Dean of the University of Auckland's medical school, said this meant it was not a fair comparison, as it did not take into account the total cost of education. Professor Warwick Bagg. Photo: Supplied "In order to enter a graduate programme, you need to have graduated from a degree. So that's a minimum of three years, possibly longer, but at least three years which will have been funded by the government if it's been completed in New Zealand," he said. The new school also had the most favourable cost-benefit ratio, at 1.986 (meaning for every dollar invested, the benefits were worth $1.99), compared to increasing Auckland and Otago's intake (1.495) and the joint rural training programme (1.798). Waikato was also estimated to have a much higher estimated proportion of new graduates that would go on to become GPs than the other two options. The analysis estimated 38 percent of Waikato graduates would become GPs, compared to increasing the intake at Auckland and Otago (23 percent) and the joint rural training programme (33 percent). However, this is only an assumption, based on figures from the University of Wollongong's medical school, which has been used as a model for Waikato's programme. "It offers a new model, provided by a new entrant, underpinned by proven performance in an Australian context. It offers the greatest opportunity to increase GP propensity," the business case said of the Waikato option. "Option 3's propensity to provide a pathway for GPs is a consequence of a purposeful curriculum, training environments connected to communities, and a different way of selecting students. It can do this as a new entrant medical school, whereas change in an existing academic institution may be more difficult." Bagg said the modelling seemed "experimental" and "speculative," and the Australian context was different to the New Zealand context. "There are very big incentives for rural general practice in Australia that, at least to date, haven't existed in New Zealand, and certainly not historically. That's an important market force that will change behaviour. To my way of thinking, they've used the most optimistic possible outcome that could be found to make the case for the new programme." He also said the rate of graduates from the existing universities working as GPs was "quite a lot" higher than what the business case reported, saying it about 35 percent were working as GPs eight years after graduation. The health minister is standing by the figures, saying Sapere's cost-benefit analysis drew upon information about the existing Auckland and Otago graduates, as well as from Australian universities with a similar curriculum to Waikato. Health Minister Simeon Brown . Photo: RNZ/Marika Khabazi Simeon Brown said the decision was a "game-changer" for the long-term growth of New Zealand's medical workforce. "The Waikato Medical School will offer a post-graduate medical qualification based on similar successful programmes in Australia. These programmes include a year-long primary care placement and encourage students to work in primary care settings following graduation. The selection criteria of students alongside their long-term placements in primary care will both support a higher degree of these medical students to work in primary care after graduation," he said. "The Waikato Medical School will support growth of the number of general practitioners who play a critical role in keeping people healthy in the community and in managing long-term health conditions outside of hospital settings. " Labour's tertiary education spokesperson Shanan Halbert said Otago and Auckland were clear that they would be able to produce more doctors faster, if they were funded to do so. "We've got to make sure we're comparing degree with degree, apples with apples, so to speak. Because what we're seeing, as an example, is that we're comparing degrees at different lengths already." The Green Party's tertiary education spokesperson Francisco Hernandez said the dumping of the documents on a Friday evening showed the government was not confident in the business case. "The cost benefit analysis repeats the main mistake the government has made that has made this such a flawed process - rather than engaging in good faith with Otago and Auckland, and running an open process for a new graduate programme, they have deliberately stacked the deck to produce the outcome they want," he said. "The cost benefit analysis also assumes no further cost escalations - and with the minister refusing to rule out further funding - we just don't know how deep the government's blank cheque will extend to back this flawed proposal." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Scoop
5 days ago
- Health
- Scoop
Hip Hip Hooray – Government Finally Updates Antiquated Funding Formula
General practice owners are delighted that the Government is modernising the way it funds community doctors to better reflect the needs of patients. Cabinet has broadened the range of factors which influence funding from just age and sex, to include deprivation, multi-morbidity, and rurality. 'The capitation system, which determines how general practices are funded, hasn't been meaningfully updated since it was established in 2002,' says Dr Angus Chambers, Chair of the General Practice Owners Association (GenPro). 'Despite numerous reviews and the widely supported recommendations of the 2022 Sapere report, little progress had been made. This lack of action by successive governments perpetuates inequities and undermines the sustainability of primary care.' 'GenPro has been calling for a funding review for years, so hats off to Health Minister Simeon Brown for finally getting it done and implemented from July next year. 'In particular we support the addition of funding criteria such as deprivation – a marker of high health needs – and rurality, as rural areas have less access to health services under the current formula. GenPro also supports regular updates of capitation every five years, starting in 2028. 'GenPro also welcomes Minister Brown's announcement of increased funding to support general practitioners in training, and putting more structure around feedback from the sector. We invite him to work with GenPro to design a health target so we can see patients as soon as we can. 'GenPro is also pleased with the announcement of a group to advise the minister on primary care. We believe that decisions made by successive ministers have suffered from poor advice from the Ministry of Health and Health New Zealand leading to the current workforce and funding crisis affecting General Practice. Better advice will be essential to a high performing system in the future. 'These are all positive signs and, along with recent funding increases announced in the Budget, indicate improvements that will make a real difference for patients.' GenPro members are owners and providers of general practices and urgent care centres throughout Aotearoa New Zealand. For more information visit
The Spinoff
06-06-2025
- Health
- The Spinoff
The Spinoff Essay: A bit of pain
'I'm lucky; I've had it for only five years or so.' David Hill on living with chronic pain. The Spinoff Essay showcases the best essayists in Aotearoa, on topics big and small. Made possible by the generous support of our members. I ache. I'm sore, nearly all the time. I'm one of the estimated 900,000 New Zealanders who suffer from chronic pain. Chronic or neuropathic pain is usually defined as pain that's lasted for more than three months. I'm lucky; I've had it for only five years or so. Multiple thousands of Kiwis have suffered for decades, or their entire life. More statistics. Over 40% of people in the UK are thought to suffer, at various times and to various degrees. (The US estimates almost 50%.) For over-75s in Britain, the figure lifts to 65%. About 80% of this is back and neck pain. In Aotearoa, a 2018 report from research group Sapere suggested that chronic pain costs our health system some $2 billion annually, plus another $15 billion in lost production and benefit costs. Utterly predictably (think housing, working conditions, $60 for a GP visit, $75 for a physio session), it affects lower socio-economic groups more. Oh, and (think trad Kiwi male stereotypes this time), women are more likely to report it than men. In my case, it's cervical spondylosis with foraminal narrowing and radiculopathy. I like to roll out the phrase so I can watch listeners' eyes cross as they wonder how much time I've got left. English translation: my neck is stuffed. Age, plus bad posture at the keyboard, means the cushioning discs between cervical vertebrae have worn thin. Bone spurs have formed. My mobility is limited; I get deep pain in the neck and between shoulder blades, plus intermittent giddiness. I've gone into detail because, like most sufferers – and I dislike that word – I usually don't say much about it. People with chronic pain get little sympathy. Who wants to hear about an ailment that goes on and on, especially when it usually comes with no bandages, slings, plaster, other visible signs of affliction? Like Chronic Fatigue Syndrome and Long Covid, it's easily seen, even by some health professionals, as self-pitying, even malingering. ' Whatever happened to 'pull yourself together'?' I heard one sceptic sniff, after an acquaintance had vented over his months of continuing hip and leg discomfort. It's the least telegenic of ailments; if we do appear on screen, we're usually caricatured as boring old whingers who need to snap out of it. ' It's all in your head,' is another common dismissal. True. Also stupid. Of course it's in the head, because that's where the brain's pain receptors are. We don't register any injury or discomfort till those receptors fire. Trouble is, if the pain continues for more than a few hours, your pre-frontal cortex starts assessing the sensation in terms of what it may mean long-term, and begins reinforcing the synapses associated with stress and discomfort. The brain's 'pain switch' gets stuck in the ON position, and your body becomes convinced of its distress. Neurologist William Davies notes that 'pain carves a path directly between the realms of mind and body'. It's called Control Sensitisation: just as Pavlov's dogs slobbered when a bell rang, almost any tug or tension for a chronic pain sufferer sends those brain receptors into power drive. It means that pain can become a habit, and like many unpleasant habits, it's hard to get rid of. A cycle of discomfort – sleep deprivation – stress – more discomfort and more stress can become established. Withdrawal and depression may follow, with the symbolic Black Dog liable to squat and crap on any of your days. So yes, it is all in the head, and it's utterly genuine. There have been some curious associated discoveries. Women's limbic system responds to pain more than men's, so women often experience greater emotional distress, while the fact that men's pre-frontal cortex is more affected means they may see the issue primarily as a problem to be analysed. And chronic pain may be exacerbated by apparently unassociated events; Brexit, the Covid pandemic, even the Trump presidency saw a rise in reported cases. You're right: the Orange Roughy can indeed become a pain in the arse. Bad news for the next few years. Chronic pain victims make unrewarding patients, even to sympathetic doctors – and not all are. Symptoms are frequently vague and diverse. We're the unwell who can sometimes seem well. Our GPs ask questions, refer us to specialists who ask more questions, at $2 per syllable, rule out nastier possibilities if you're lucky (and that is indeed a help), and usually intone variations on the theme of 'y ou'll have to live with it'. I sympathise with them, actually: as with Chronic Fatigue or Long Covid, we seldom give them the satisfaction of finding a specific cause. So chronic pain is a formless and often unresponsive condition. It can take a long time to get a diagnosis, and it seldom comes with any clear path of action. It can be treated, but seldom cured – whatever that last word may mean. What are the treatments? Painkillers, anti-inflammatories of course, though all of them, except perhaps paracetamol, come with potential side effects. A TROUP (Trends and Risks of Opioid Use for Pain) study in the US found that 22-26% of people prescribed opioids for non-malignant chronic pain ended up misusing their drugs. Distraction, meditation, exercise, diet, therapy, physio and chiropractic, the analytical and shared talk of Cognitive Behavioural Therapy are other courses of action – and action is an early step to taking some degree of control. The New Zealand Pain Society (you'll find them online) offers sensible, practical programmes and resources. Complex Chronic Illness Support, also online, can help as well. Our local hospital used to run chronic pain workshops, where physio, dietitian, psychiatrist, counsellor would reassure attendees that they weren't malingerers; it was a genuine ailment, and here was a list of things that might help. They're the only workshops I've ever attended where some participants stood up every 10 minutes and lay down in the aisle for a bit. They were enormously valuable for their collegial quality, finding that you weren't the only sufferer. They've been discontinued – more funding cuts at Whatu Ora, I gather. Alan Gordon in his book The Way Out estimated that in 2021, there were 1.2 billion chronic pain sufferers worldwide. The number is rising: we're living longer and hurting for longer periods. Other contributing factors include people expecting to be pain-lite and becoming more inclined to seek help when we're not, plus our living in an increasingly isolated society, where loneliness aggravates almost any condition. The outlook isn't great. The future, for me at any rate? Keep learning – in the most positive sense of the verb – to live with it. Take unexpected solace from the fact that on good days, the world can seem brighter and more rewarding than it did before my neck started to pack up. And wonder if assault with the nearest deadly weapon might be a pretty reasonable response to anyone who tells me that it's all in my head.
The Age
03-06-2025
- Automotive
- The Age
Victoria's first petrol price app could increase prices, but still worthwhile: report
An app displaying real-time fuel prices at Victorian petrol stations will cost about $2.4 million a year to run and may only save customers $5 or $10 a year – and could contribute to price increases – but will still be worthwhile, research has found. The Allan government wants to publish up-to-date fuel prices on the Service Victoria app to save drivers time in finding the cheapest petrol. The scheme would cost the government $1.3 million and the industry $1.15 million per year to run, totalling an annual $2.4 million. Consultants asked by the government to assess the plan say it's unclear whether it would decrease costs for consumers — or increase them. Some fuel price transparency schemes lead to cheaper prices, while others lead to higher prices, advisory firm Sapere said. But Sapere concluded that real-time price disclosure would still be worthwhile by saving motorists time. 'On balance, we expect that in the medium to long-term there will be net benefits,' it said in its recent regulatory impact statement. Victoria is the only state or territory without a fuel price transparency scheme. The Australian Competition and Consumer Commission, which monitors the retail price of unleaded petrol, diesel and LPG, found Melburnians could have saved $333 by comparing petrol prices in 2023. Unleaded prices currently range from as low as $1.49 a litre to as high as $2.09 a litre. It takes about 6½ weeks for Melbourne's petrol prices to move from a low point to a peak and back to a low point.
Sydney Morning Herald
03-06-2025
- Automotive
- Sydney Morning Herald
Victoria's first petrol price app could increase prices, but still worthwhile: report
An app displaying real-time fuel prices at Victorian petrol stations will cost about $2.4 million a year to run and may only save customers $5 or $10 a year – and could contribute to price increases – but will still be worthwhile, research has found. The Allan government wants to publish up-to-date fuel prices on the Service Victoria app to save drivers time in finding the cheapest petrol. The scheme would cost the government $1.3 million and the industry $1.15 million per year to run, totalling an annual $2.4 million. Consultants asked by the government to assess the plan say it's unclear whether it would decrease costs for consumers — or increase them. Some fuel price transparency schemes lead to cheaper prices, while others lead to higher prices, advisory firm Sapere said. But Sapere concluded that real-time price disclosure would still be worthwhile by saving motorists time. 'On balance, we expect that in the medium to long-term there will be net benefits,' it said in its recent regulatory impact statement. Victoria is the only state or territory without a fuel price transparency scheme. The Australian Competition and Consumer Commission, which monitors the retail price of unleaded petrol, diesel and LPG, found Melburnians could have saved $333 by comparing petrol prices in 2023. Unleaded prices currently range from as low as $1.49 a litre to as high as $2.09 a litre. It takes about 6½ weeks for Melbourne's petrol prices to move from a low point to a peak and back to a low point.
