In Oz there is tension over the public sector losing out in budget tussles with private-sector providers

In Oz there is tension over the public sector losing out in budget tussles with private-sector providers

Political fallout from HSJ's leak of the NHS's pay and workforce strategy is but a rumour in the Antipodes, from where I write. But travel serves to emphasise how much our hopes, fears and healthcare issues in the developed world are increasingly similar and interconnected.

One cheery piece of news I spotted in the New Zealand Herald - that MRI scanners can now reveal layers of lethal fat inside people who look complacently thin - turned out to stem from research being done in labs at Imperial College London.

Little wonder then that the same edition contained a Kiwi version of the UK's fierce debate on Herceptin. As in Britain, anxious families have remortgaged their homes to buy mum the anti-breast cancer drug (and pay local VAT on it) because Pharmac, the NZ government's equivalent of our own National Institute for Health and Clinical Excellence, is not yet prepared to fund it. The Kiwi health budget apparently spends half the developed world's average per head on drugs.

Our trip was designed to visit my wife's extended family in NZ and Australia and allow me to see more of Oz's wide open spaces than I had previously managed. This included the Ghan rail journey, 1,800 miles across the vast Northern Territory, mostly desert from top to bottom, and sparsely populated. The Royal Flying Doctor Service cannot pay too many home calls in the outback. Most cases of 'remote health' are handled on the phone.

The populated east coast, with its white tourist beaches and glittering surf, is a different matter. My wife's GP cousin has just moved there from a rural practice where he delivered an average 70 babies a year. Now he is trying to juggle public- and private-sector work to make what will be a reduced living.

Rural doctors are a powerful, emotive lobby in Australia and well paid accordingly. Aussies have basic health cover, plus private top-up insurance, as in France. The system is generally well regarded, though always under pressure. My in-law and his new colleagues are struggling to maintain one obstetrics and gynaecology service where the state of Queensland's flat fee for doing an emergency Caesarean an hour's drive from their base is $169 - just over£50.

In New Zealand a few days later I heard another cousin - a psychiatrist - describe patient problems and flawed remedies which students of Australian-born Patricia Hewitt's new Mental Health Bill would recognise. I left him a copy of the bill, lucky chap. Since NZ has long imported doctors (many of their own go overseas) he complained in passing about aggressive behaviour from overseas doctors who avoid treating poor and difficult patients.

How could they do that, I asked? By staying in private practice, where the state picks up 80 per cent of the bill at generous private rates of remuneration, such doctors manage quite comfortably on bulk billings without troubling patients for the remaining 20 per cent, he replied.

As in Oz, there is clearly tension over the public sector losing out in health budget tussles with private-sector providers funded by Kiwi tax dollars. Is this the shape of things to come in Britain, or do the common complaints about preferential rates paid to private providers of NHS services (or PFI contractors) mean we already have our own version?

I hate to end an enjoyable trip on a down note, so I won't. I am typing this in the home of my wife's aunt, a widow on modest means who lives alone on a wooded cliff top high above the blue Pacific. She is 86 and has had her share of old age's illness and disease, including emphysema and, last year, a broken hip.

Her widowed sister (the new boyfriend has gallantly not yet asked her age) lives alone a mile along the cliff and copes with her own share of ailments. One sister writes (unpublished) fiction, the other became a painter in her 70s. The house is full of abstract canvases, large and vivid. The aunts get weekly home help, but even at reduced oldsters' rates they pay to see the GP and for a prescription. Hospital care is good, but you have to wait.

Fifty miles from their nearest offspring they live busy, unassuming lives. It reminds me that good health in old age is not just about luck, genes or healthcare. It is also about good attitude, something politicians and doctors should do more to foster. It's cheaper, too.

Michael White is assistant editor (politics) of The Guardian.