Michael White on public health nudges

"This bottle contains 8.3 glasses" - by the Kiwi standard measure.

That was a bit of a blow to my holiday habits, albeit one I managed to overcome by ignoring it. On the White standard measure, a 750ml bottle of white wine counts as six units.

Never mind: the old cliché states that travel broadens the mind and it is as true of healthcare as anything else. Not all Kiwi wine labels carry a unit count, but it seems a sensible "nudge" towards moderation, as does much else in this sensibly social democratic country.

It all seems far from Whitehall's new deal to access drugs deemed too costly by the National Institute for Health and Clinical Excellence, or ex-health secretary Alan Milburn's return to chair a commission on social mobility for his old sparring partner, Gordon Brown.

Remember how they fought over the financial freedoms of foundation trusts? The wounds have healed, though scars remain. Milburn misses the fray.

New Zealand's version of social mobility involves ensuring a fair deal for its Maori minority. But Kiwis have most of the same healthy eating issues as everyone else in the developed world, not to mention the fast-developing world of nearby South Asia, where I also visited Malaysia and Singapore (plus Oz) over Christmas.

In Malaysia, so I learned, the government has pledged to spend 5 per cent more on public health this year in response to demand from its fast expanding middle class, with their western consumer habits that, inevitably, include McDonald's.

That does not mean that the kidney dialysis centre at Singapore's Miri Hospital does not have to appeal for private donations ("tax deductible") to fund a much needed expansion.

Sounds familiar? Indeed. Less so is the means testing of patients in public hospitals, which Singapore introduced on New Year's Day. Needless to say it is complicated, but it seems to mean that flat rate state subsidies on the cost of inpatient treatment, up to 80 per cent for the low paid, elderly or unemployed, will be scaled back to 65 or even 50 per cent for the better off.

Patients who refuse to allow hospital administrators to check their income will automatically get only the smallest subsidy. I mention this not because this sort of change is going to happen in Britain tomorrow, but because Singapore is a modern city state, wealthy and smart. What it does is worth noting.

Fast forward to Australia, where two members of my wife's family are doctors with UK NHS experience. Bill now works solely in a private GP practice, which charges patients AUS$50 (around£25) per consultation.

His wife claims the money from health insurers, who usually knock $5 or so off any claim. It is not worth fighting, she says. Australians are encouraged to take out health insurance and penalised by the tax system if they don't.

Cousin Bob is working his way up the Aussie public hospital system as a junior doctor. In Britain he did more hands-on work, under supervision. Here he watches the registrar do it. End result? Much the same, says Bob. But Australian doctors have more time, less pressure, he says.

New Zealand is gentler, milder than its brash big neighbour in every way.

But here too there is evidence of that very British debate on health - co-payments. Thus hospital treatment, including accident and emergency, is still free. So are scrips (if you are under six or in hospital), most lab tests, pregnancy treatments, etc. But GP visits are among those items "subsidised but not free". So adults pay NZ$45-$50 (around£20) to see the doctor, three quarters the cost.

Ambulance trips cost a little more, scrips a basic $15 (£6), though you pay a "manufacturer's premium" on costly ones and pay the full cost on some.

Sounds familiar too? And I read of plans to tackle the high Kiwi "no show" rate for hospital appointments and warnings to health boards not to make damaging cuts in the global recession. That affects everyone too.