COMMENT:

Today we report a case of an Auckland woman who has been told she is at risk of a heart attack or stroke and has to wait nine months for an echocardiogram scan that will show whether she needs urgent heart surgery. If her wait sounds all too common, it probably is. That is why it is serious.

Long waits are endemic in the public sector and they should not be. A person with private health insurance would probably have one of these scans, and more besides, within days, if not hours of being diagnosed with symptoms of a heart attack or stroke. There seems no good reason that the public system cannot provide the same service.

It may be that the reason it cannot is that surgeons and other specialists are better paid by private insurance providers and have an interest in making uninsured patients wait for their attention in public hospitals. If that is the reason it is not a good one. It is well past time for a government to remove this conflict of interest, perhaps by employing specialists to work full time and exclusively in the public sector.

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It could be a condition of the training medical specialists receive from taxpayers that they have to work in the public sector for 10 years or so. Professional bodies would oppose these suggestions fiercely, arguing young doctors would be unwilling to do specialist training and those that did would go overseas when they graduate. Let us see. If indeed, it became a problem, the public sector could recruit overseas.

More likely the only thing to suffer a little would be surgeons' incomes and all potential patients would be better off, whether they depended on public health priorities or were paying private insurance premiums.

But until a government has the courage to take some such action, the country will continue to agonise over waiting times for tax-funded health treatment and governments will constantly face constant pressure to give district health boards whatever funds they need to clear their waiting lists.

It is unsatisfactory that a patient such as Maureen Christian in our report today has to wait not for the heart operation she may need, but for an ultrasound scan of her heart that will show whether or how urgently she needs one. Even for this she faces a wait of 40 weeks.

It is already nine weeks since a specialist at Middlemore Hospital, where she was being treated for pneumonia, noted on her discharge form that she needed an echocardiogram within six weeks. But last week she received a letter from the Counties Manukau DHB telling her it would 40 weeks. She is 79, and already taking medication for high blood pressure.

The board's chief executive told the Herald its heart patients are placed in one of five bands of urgency by a cardiologist. It aims to give those with the highest priority an echocardiagram within two weeks. The second band may get one within six weeks and the third, 12 weeks. Those reckoned least urgent may wait 46 weeks. While all wait their condition may be getting worse.

This is just one of many deficiencies in the health system highlighted by the Herald in recent weeks. Health is too important to be severely constrained by public budgets and too important for patients to be made to wait unless they are insured.