KEY POINTS:
It used to be that people awaiting non-urgent treatment in the free health system languished on waiting lists. Now they languish off waiting lists. Officials have devised a solution worthy of a Yes, Minister script. Instead of putting all referrals on a waiting list, health boards must now assess patients' urgency and accept only as many as they can treat within six months. Thus waiting lists cannot grow to politically embarrassing proportions. Problem solved.
Successive health ministers have said yes to this political solution. The incumbent, Pete Hodgson, argues the system is more "honest" because it accepts only those patients that can be seen. It is anything but honest. It is shuffling patients off waiting lists until their condition deteriorates sufficiently to rate more points on a priority measure. And district boards may be fined by the Ministry of Health unless they operate this subterfuge.
The result, as a Herald series has reported over the past two days, is wildly variable prospects of treatment for some conditions in different districts and as time goes on patients are having to get sicker to get service. For a common procedure such as hip replacement, for example, sufferers in South Auckland or Waikato may be listed for treatment when they can still walk, with difficulty, to their letter box. In Auckland, Waitemata or Bay of Plenty they will have to wait until they can barely put on their shoes. In Otago they may not qualify until they are practically on crutches. And these levels of disability, remember, are required merely to get on the waiting list. Surgery may still be six months away.
The solution, for anyone who can afford it, is private health insurance. Public hospital waiting lists are a boon to the private sector. But, as our series suggests today, private hospitals are a mixed blessing. They can treat non-urgent patients immediately, saving the various costs that disabled people place on the public services while they await surgery. But by "cherry picking" the more straightforward cases, the private sector leaves public hospitals to do the difficult, expensive work, which can become even more difficult and expensive without the volume of routine surgery.
But that sounds like an excuse for what still seems to be vast and murky inefficiency. Public hospitals are soaking up ever more taxpayers' funds for little or no discernible increase in the number of operations. Better pay for nurses, junior doctors and other staff has not brought noticeable improvements in efficiency. Patients still wait months for surgery while operating theatres are underused. The likes of surgeons and anaesthetists still lament the poor resource use and managerial eccentricities they see in the system.
Free services of any sort always struggle to reconcile demand and supply. Without an admission fee there is nothing to deter unnecessary use. There is nothing to stop doctors, who do charge a fee, from putting an uninsured patient on a waiting list just as a precaution, in case the patient's condition deteriorates. It happens, and there is no harm in a system that imposes its own assessment and sends the patient back to the doctor for monitoring in the meantime.
But the criteria for acceptance on a waiting list should be reasonable and consistent across the country, it should not depend on the number the district board can comfortably treat over six months. That is not honest or fair to patients and the paying public. The health system must do better.
