KEY POINTS:
When you meet someone disabled or in pain because they can't get a hip replacement or varicose vein surgery, the health system seems unfair.
It seems even more unfair when thousands of people like this are removed from hospital waiting lists because they are not considered sick enough.
But it is harder to judge if elective services - necessary but non-urgent treatment - are becoming harder to get in the public health system, which is being forced to change the way it works.
For some treatments, such as hip replacement, thresholds for surgery have gone up in some districts and down in others. But the general long-term trend in elective treatment is causing surgery such as hernia repair and varicose vein removal to become almost unobtainable unless patients are in significant pain or have complications.
Heart bypass surgery delays remain a problem for non-emergency patients in Auckland, the latest reason being a shortage of intensive care nurses at Auckland City Hospital.
"Someone who should get an operation within several weeks is waiting several months," said one senior source.
The number of patients receiving elective surgery was little higher in 2005 than in 2000, although the Government cites increased numbers of medical and acute surgical patients and the growing complexity of treatment.
Last year, many patients were removed from public hospital waiting lists to comply with a Health Ministry demand that people be put on assessment and treatment lists only if they could be seen within six months.
It threatened health boards with financial penalties if they did not comply.
As the deadline approached, the Government admitted that in a one-year period, between 17,000 and 27,000 patients waiting for assessment or treatment were being sent back to the care of their GPs.
Its previous estimates of the annual figure was 10,000 to 14,000.
Surgeons and specialists want to be able to treat all those they believe will benefit. Healing the sick is their job. And that's partly why lists have grown.
Conveniently for the Government, a Southland specialist was last year ticked off by the Health and Disability Commissioner for unrealistically marking most of his patients "urgent".
Elective services have long been contentious. In government, Labour and National have argued that because health rationing is a fact, it is necessary to treat non-urgent patients by need - sickest first - rather than by how long they have been waiting.
National introduced the booking system for elective surgery 10 years ago to try to enact this idea. Labour in opposition opposed the waiting lists; in office, it has kept them but tried to improve the system.
Waiting times have been cut to six months, but anyone not on the list is not regarded as waiting - although it feels and looks like waiting.
Not all waiting lists are the same under Labour. The active review list was introduced for people not sick or disabled enough to get on to the real waiting list.
Health Minister Pete Hodgson accepts that waiting lists remain a problem, but says the system is more honest because it accepts only those patients who can be seen.
He told the Cabinet in a paper last year that because New Zealand's public hospitals provided "world class" care for acutely unwell or injured patients, elective services had become the yardstick.
Inability to obtain such services eroded trust in the public system.
He acknowledged that high thresholds in some specialties caused significant disability and distress.
Surgical gaps he cited were lack of breast reconstruction for mastectomy patients in some areas, and delays for some children with congenital conditions.
The paper was published with the announcement that an extra $60 million a year would be spent to boost elective procedures by 10 per cent.
This money is available only to health boards that comply with the "six months plus six months" waiting time policy.
Boards must also increase the number of specialties using a national scoring system, to allow easier comparisons of how sick patients must be to obtain treatment in each health area.
This followed earlier dollops of extra money to double the number of hip and knee replacements and increase the number of cataract operations by half.
In some respects the new spending is working.
Counties Manukau started earlier than most on implementing the six month policy and got a head-start on spending some of the new money.
It has also been helped by Waitemata opening an acute orthopaedics service, sharing the regional load with Counties and Auckland.
Counties' access threshold for hip replacements has dropped significantly but it still has problems in plastic surgery.
"It's almost quicker at the moment to get a hip replacement at Middlemore than in private," said Counties surgeon Garnet Tregonning. "That's not going to last long."
