Hundreds of patients are waiting too long for elective surgery and at some hospitals higher levels of pain and disability are being demanded just to get on the list.
At last count, in March, none of the 20 district health boards had managed to treat all the patients promised elective (non-urgent) treatment within the required four months. Some 750 patients nationally - more than 200 at Waikato DHB - waited more than four months.
Nationally the problem is worst in orthopaedics, in which nearly 5 per cent of patients - 280 people - had not been treated on time.
The Labour Party and surgeons point to DHBs' lifting thresholds for access to elective surgery.
Six DHBs have increased the number of points required by patients to be wait-listed for a hip replacement, according to responses under the Official Information Act. Some had reduced the number needed, which measures things such as independence and ability to care for oneself and several had made no change.
"They're not keeping up," said Labour health spokeswoman Annette King. "There's huge inequity. In Canterbury, hip replacement needs 90 points [out of 100]. In Auckland DHB its 50.
"Because they have a nationally consistent prioritisation tool for orthopaedics, they need to apply it equitably across New Zealand, say 70 points and they need to provide surgery so you don't get post-code surgery."
It was "damning" that while the proportion of elderly in the population had increased, the Government's target for the per-capita number of cataract, hip and knee surgeries - operations more common in older people - had not risen since 2011.
Health insurers' association chief executive Roger Styles said, "There's more public and private money being spent on electives. Demand is increasing so rapidly the money doesn't keep up."
Research for his group and private surgical hospitals indicated 110,000 people were on official waiting lists but a further 170,000 had not been placed on lists despite being told they required elective surgery. People who had received publicly-funded elective surgery had waited on average nearly six months for treatment.
Orthopaedic Association president and Otago surgeon Professor Jean-Claude Theis said people in some areas were now finding it harder to get timely joint-replacement surgery. Of 10 patients at one clinic he had run this year who needed hip replacement, only three or four would get their operation within four months. The others were sent back to their GP.
One of the latter is a farmer. "He wakes at night with pain. He has to take regular pain relief. He's at risk of having to employ [an extra] worker or not being able to run his farm."
He said it was easier to get publicly-funded joint replacement surgery in Auckland than Otago because Auckland's higher rate of health insurance coverage removing people from the public system.
Health Minister Jonathan Coleman said that as Kiwis lived longer, elective surgery demand was increasing and the answer was to do more.
His government had increased elective surgeries by around 7000 a year, five times more than Labour achieved.
His data shows National has increased the annual number of elective surgeries by 42 per cent since 2007/08, but the number of joint replacements - a priority area for Labour - has increased by far less: 26 per cent.
"The increases in joint replacements aren't even across the country," Dr Coleman said.
"Southern DHB needs to do better than its 10 per cent increase between 2008 - 2015."
Hip replacement years away
Pills have become essential to help dull the pain in Jenny Abercrombie's worn-out right hip.
There's codeine, paracetamol and an anti-inflammatory and she can't imagine life without them after being rejected as insufficiently disabled to qualify for state-funded hip-replacement surgery.
"It's too horrendous to think about. You just couldn't do anything," said the 52-year-old, a part-time shop assistant in a Four Square. "Some days are not so bad; it's still sore. But the nights, I just can't get to sleep it's so painful. I finally got my doctor to get me to see a specialist, but they declined me for an operation. The specialist said it could be up to five years before I get mine done."
The Southern District Health Board's letter said: "The specialist has recommended that you would benefit from this surgery however your current condition falls below the level of need at which we are able to offer you surgical treatment at this time. ... We are therefore returning you to the care of your GP, who can discuss alternative options with you, which may include seeking treatment in the private sector."
Eric Hooks, 67, a self-employed business consultant who says that some days the pain in his left hip is so bad he can hardly walk, got the same letter.
"I have got two young grandchildren, a boy coming up 8, he's sports mad, always asking me to 'come and play cricket, granddad' and kick a ball around. I just can't do it," he says.
Mr Hooks and Mrs Abercrombie say they cannot afford to pay for private hip replacement surgery, which costs around $25,000, and neither has health insurance.
Mrs Abercrombie, too, is concerned about the effect on her grandchildren, whom she cares for after school.
"If it gets any worse I won't be able to do those things. The frustrating thing is if they did something about it now I could carry on with my life."