Southern Cross tightening bowel cancer screening rules

Photo / Martin Sykes

New Zealand's largest health insurer Southern Cross is tightening the rules on access to bowel cancer check-ups in a bid to control rising costs.

From September, members will be funded for colonoscopies and gastroscopies - specialised intestinal investigations and procedures - and cataract surgery only at clinics which are contracted to Southern Cross.

The insurer says the move is not related to the Government's plans to set up a bowel cancer screening programme over the next few years.

A national screening programme will greatly increase demand for colonoscopies. Public hospitals, although increasing their capacity, have had difficulty in the past in coping with demand. However, any private referrals from the programme would be funded by the state, not private insurers.

"Colonoscopies, gastroscopies and cataract extraction are among the most common elective procedures delivered in the private health sector," Southern Cross Health Society chief executive Peter Tynan said yesterday. "In 2009, they accounted for over $50 million worth of surgery and nearly 10 per cent of the elective surgical services claimed by Southern Cross members."

Southern Cross, which has 840,000 members, is putting the three procedures - and in some regions optical coherence tomography too - under its "affiliated provider only" system. This system is already used for a small proportion of Southern Cross-funded services, including varicose veins surgery, laparoscopic prostate gland removal and heart angioplasty using drug-releasing stents.

"Strengthening the affiliated provider network is an effective way of stabilising claims cost escalation long-term," Mr Tynan said.

Nationally 35 private clinics incorporating 130 specialists provide endoscopy (colonoscopy and gastroscopy). So far just eight have signed with Southern Cross as affiliated providers.

"We are [in talks] with colonoscopy specialists/facilities across the country and are confident we will have the majority signed as affiliated providers by the end of the year," Mr Tynan said.

But surgeon John Dunn, the chief executive of Endoscopy Auckland, which provides one-third of New Zealand's private endoscopy, expressed reservations about the extension of the affiliated provider-only scheme. His clinic had not yet signed up, but he said there was little choice but to do so.

"This was announced without any prior notification ... so at present we are trying to gather information."

INCREASING CHECK-UPS

Southern Cross colonoscopy claims:

*2007/813,331

*2008/913,949

*2009/1014,380