Health Minister Jonathan Coleman likes to think New Zealand's health system is the envy of the world, and even some of those people in the sector who aren't particularly impressed by the minister think he has a point.

"We do have a good health system. It compares favourably overall internationally but it has nothing to do with the leadership of this minister," Association of Salaried Medical Specialists (ASMS) executive director Ian Powell said.

"All that means is that our system is better able to function in an environment of under-funding than other systems, but that is no excuse for the level of poor leadership we have had," he said.

JOHN BISSET Ian Powell: good health system "nothing to do with the leadership of this minister".

"Coleman's comment about a system to envy has nothing to do with his performance and everything to do with him latching onto a health system based on good sound principles."

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Coleman made his proud boast this week at a political debate in Wellington organised by Cango - a group of nine prominent cancer charities. "If you stand back and go to the World Health Organisation, where I was two months ago, you will realise we have got a health system that's the envy of the world," he said.

Dr Chris Jackson:. systems and resources falling behind.

As far as Cango chairman Graeme Woodside is concerned, the claim is wrong when it comes to cancer.

"Our health system in general is certainly superior to that of many countries, but we are seriously lagging behind in some areas and the minister seems to be oblivious to that," Woodside said.

"Australia, for example, has had access to a number of drugs we still don't have access to and that's simply not good enough.

"People are experiencing serious delays to treatment and some are dying unnecessarily because our health system is failing them. Kiwis don't have access to the screening or treatment programmes that other countries offer and the fact that our minister doesn't seem to recognise that is concerning."

Coleman does get some support from the US-based Commonwealth Fund, which tends to focus on what's wrong with the health system in the US, but as part of doing that it looks at what is being done right elsewhere..

In a survey of the health systems of 11 wealthy countries published in July, it ranked New Zealand as fourth-equal overall, behind the UK at the top of the list, Australia in second and the Netherlands third.

Despite that, New Zealand is in the second half of the field in three of the five areas looked at by the survey.

We're seventh when it comes to access, which is about affordability and timeliness. We're also seventh on health care outcomes, and eighth on equity, which looks at how the system works for higher and lower-income people.

New Zealand's best performance is a second for administrative efficiency, and a third for the care process.

New Zealand Orthopaedic Association president Richard Keddell considers much about the health system is good but sees a problem with access to elective surgery for an increasing number of people who would benefit from it but aren't in the greatest need.

"There are certain parts of our health system that are certainly the envy of the world, and other parts aren't," Keddell said

"Our trauma management, our acute management is very well respected around the world. If you get bowled over on the road here you will get as good treatment as you will anywhere in the world," he said.

"Our ACC system is very highly regarded around the world. The standard of our elective surgery is very well regarded."

The way elective surgery was organised was quite fair. In theory, and to a fair extent in reality, those in the greatest need were treated first. "But there's an increasing number of people who are in that middle level who would definitely benefit from surgery, who aren't able to get it," Keddell said.

Looking at knee replacements, the rate at which they were carried out in this country was similar to that overseas.

"However a significant proportion of those in this country are done in the private sector. That's a little different to some other countries we're compared with. If you look at the number funded by the public system, then we're lower than some of the other countries in the OECD we're measured against," he said.

"That reflects we have a dual system in this country. That's one way to deal with the need."

The biggest problem was that demand was expected to increase significantly. "We need to look at innovative ways of managing that, and that's not just throwing money at it."

Arthritis New Zealand chief executive Sandra Kirby said this country's health system was not world class from the perspective of many of the 624,000 Kiwis living with arthritis.

"It's well-known there is a shortage of rheumatologists in New Zealand, for example, and access to an arthritis specialist very much depends on where you live," Kirby said.

The internationally recommended ratio was one rheumatologist for 100,000 people. In many parts of this country there were more than 200,000 people for each available specialist. Patients in New Zealand were at the end of the queue for cost-effective innovative medicines compared with other countries. Five of the latest biologic arthritis medications were not funded in this country.

Cancer Society medical director Dr Chris Jackson said New Zealand had many world class doctors, nurses and health professionals, but the systems and resources were falling behind.

"New Zealand has the highest rate of melanoma in the world, and one of the worst death rates from bowel cancer in the world," he said.

"You are more likely to survive cancer in Australia than you are in New Zealand. The gap in survival from cancer in Australia and NZ is actually widening.

"We have one type of drug funded for melanoma, Australia has three. Australia has five types of drugs for bowel cancer, we have three," Jackson said.

"You can get immune therapy for lung cancer in Australia, and you can't in New Zealand. We are behind Australia the UK, Ireland, and most of Western Europe when it comes to rolling out a bowel cancer screening programme."

The ASMS's Powell said one benefit of the New Zealand health system was that it was universal, unlike that in the US which was a "crap system with so many people denied access".

It was also unitary, unlike Australia where "enormous rubbish" went on between the federal and state health systems, Powell said.

The district health system also had enormous pluses, with district health boards providing an integrated and coordinated approach.

"I think we probably get a better return for the health dollar than most countries, if not all, because of our structure," he said.

But despite being a good system, there were some bad outcomes. "We have had patients going blind ... through a fault of leadership right up to the top".

New Zealand's rating in the Commonwealth Fund study had to be put in perspective.

He had just returned from the UK, and that country's National Health Service, which topped the survey, was in "absolute turmoil".

"That's due to a level of under-funding much more severe than in New Zealand, and also due to a lot of ideologically driven structural change in the UK."

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