A Dunedin pharmacist has raised concerns about the \u2018\u2018enshittification\u2019\u2019 of New Zealand\u2019s healthcare system, which is slowly dissolving services to people and increasingly serving \u2018\u2018scale, profit and efficiency\u2019\u2019 instead.<\/p>\n
The term was coined by Canadian-British author Cory Doctorow to describe the deliberate, gradual degradation of online platforms and services, which lure users in with high-quality service, before locking them in and extracting all remaining value for shareholders, resulting in a poor user experience.<\/p>\n
Roslyn Pharmacy owner Andrew Hou said he was a little dismayed when he first heard the term from some young people. After researching the term online, he discovered it accurately described what was happening to New Zealand\u2019s healthcare system.<\/p>\n
\u2018\u2018Enshittification describes what happens when systems slowly stop serving people and start serving scale, profit and efficiency instead.\u2019\u2019<\/p>\n
He said more and more independent GP clinics, pharmacies, dentists and physios were being bought by chains with centralised systems, targets, key performance indicators, flashy slogans and even celebrity endorsements – many of these changes tended to put profit before people.<\/p>\n
\u2018\u2018It\u2019s happening across the world, not just New Zealand.<\/p>\n
\u2018\u2018Fully funded public systems are under pressure.<\/p>\n
\u2018\u2018If you look at the NHS [National Health Service] in the United Kingdom or the health system in Australia, it\u2019s all the same.\u2019\u2019<\/p>\n
Some of the changes were genuinely helpful, but the \u2018\u2018trade-off\u2019\u2019 was relationships with members of the community and the continuity of their care.<\/p>\n
The new 12-month prescriptions were adding to the problem.<\/p>\n
From February 1, New Zealanders with stable, long-term conditions such as asthma and diabetes will be eligible for 12-month prescriptions, up from the present three-month limit.<\/p>\n
While it meant fewer GP visits, lower costs and more convenience, patients not seeing their GP or pharmacist regularly might lose control of their medical conditions, he said.<\/p>\n
\u2018\u2018For me personally, I take an anti-hypertensive – a tablet for my blood pressure.<\/p>\n
\u2018\u2018I lost a bit of weight after Christmas and, because of that, my blood pressure\u2019s actually naturally decreased, so my dose of blood pressure medication is too high now.<\/p>\n
\u2018\u2018I would go for a wee run and I\u2019d be a little bit dizzy.\u2019\u2019<\/p>\n
Because he is a medical professional, he knew he needed to reduce his dosage, but many others in the same situation might not.<\/p>\n
The problem would usually be discovered by their doctor or pharmacist when they renewed their three-month prescription.<\/p>\n
\u2018\u2018But on a 12-month script, they may only find out when they end up in an ambulance or accident and emergency.<\/p>\n
\u2018\u2018It\u2019s putting people at risk.<\/p>\n
\u2018\u2018And if a person has a heart attack and dies, who\u2019s liable for that?\u2019\u2019<\/p>\n
In a worst-case scenario, he said the health system could decay to a point where it was not functional any more, or patients would just start dying because they were not being seen enough.<\/p>\n
\u2018\u2018That\u2019s the greatest fear.<\/p>\n
\u2018\u2018The only way to \u2018un-enshittificate\u2019 our healthcare system is for New Zealand to just look after its healthcare system \u2014 we need to fund it appropriately and look after it.<\/p>\n
\u2018\u2018The whole health budget and decision-making needs to be ring-fenced so it doesn\u2019t change every three years.\u2019\u2019<\/p>\n