New Zealand’s healthcare system has long grappled with the issue of a two-tier health system, where some services are only accessible to those who can afford to pay. While many argue that essential health services remain free for all, this raises questions about justice and moral ambivalence.
The sufficiency of the public tier and erosion of the public system
A just two-tier health system relies on the first public tier providing sufficient and comprehensive healthcare services. However, the adequacy of the public tier has been a subject of continuous debate. To be considered sufficient, healthcare services should encompass vital goods and services essential to human flourishing. This includes more comprehensive and universal access to primary and oral healthcare and timely access to cancer treatment.
Accepting a second private tier of healthcare hinges on the quality and sufficiency of the first public tier. If the services in the public sector are lacking, the justification for the existence of a private tier weakens. Private clinics may claim to relieve pressure on the public system, but in reality, they often capitalise on the inadequacy of the public system by offering services to patients who couldn’t find timely treatment in the public sector.
The proliferation of private-sector facilities may inadvertently or intentionally deplete the public sector instead of supporting it. Private healthcare providers profit from the failures of the public system, which can exacerbate the growing gap between services available in the private and public tiers. This gap threatens social cohesion and solidarity as it creates a divide between the better-off and worse-off individuals, with access to social goods and privileges becoming inaccessible to some.
Addressing entrenched inequities and pursuing universal healthcare
New Zealand’s healthcare system was built on commodifying healthcare services, allowing medical professionals to charge fees. This has contributed to entrenched health inequities, particularly between Māori and non-Māori New Zealanders. While a two-tier system may persist, steps should be taken to make it more just and equitable.
The focus should be on ensuring that all “vital goods and services” are securely provided in the public sector. This requires political leaders to prioritise universal healthcare and commit to preserving opportunities for everyone. Fundamental shifts in thinking about the public-private divide are necessary to achieve this goal. Leaders need to stand with the public in supporting universal healthcare and recognise that it requires reevaluating the current two-tier system.
Only then can New Zealand truly address entrenched health inequities and build a more equitable and inclusive healthcare system.