Public vs private
Wait times for surgeries have long been a contentious issue. In part three of this five-part series Natalie Akoorie examines the social and financial costs of a two-tier health system
There are some who argue private practice is complementary to the public system, but at what cost?
A 2005 Ministry of Health report to then-Health Minister Dame Annette King pointed out barriers to reducing inequalities arising from the conflict of interests in dual practice which affected those who had little option but to rely on the public system.
“As Ma¯ ori and Pacific people are over-represented in the highdeprivation deciles, this affects these groups as well as other lower-income groups more than other New Zealanders.”
Another disadvantage was the reduced time available for specialists to train junior doctors in the public system when they are off-site working in private practice.
In 2017 Waikato Hospital began a $2.4 million project to sort out its “spaghetti bowl” surgical system after the death of a baby during delivery because of a delayed caesarean section, as well as lobbying from doctors and spending $25m annually on outsourcing elective surgeries to private hospitals.
The project by Australian consultants Keezz was initiated after Waikato District Health Board (DHB) was put on notice by
the Medical Council over the training of junior doctors in orthopaedics because of a serious imbalance in the types of surgeries they were learning.
Registrars were not performing enough elective surgeries to meet training requirements, putting the DHB at risk of losing accreditation in orthopaedics.
Public affairs executive director Lydia Aydon said so far the project had saved the DHB just under $10m each year in better managed surgeries.
The DHB’s interim chief operating officer, Ron Dunham, said some wait times had improved although this varied across specialities.
“More efficient processing of acute presentations frees up capacity for planned procedures.”
That’s not to mention that a vast number of the electives shuffled into private hospitals are paid for with the public purse, through ACC.
The fact the public health sector was alone in allowing a key segment of its workforce to be engaged in private activity outside their public sector work had not gone unnoticed.
“Other sectors, such as telecommunications, and the New Zealand public service, do not allow employees to work for competing organisations, or in any capacity that may lead to a conflict of interests,” the
report to King stated.
At the opposite end of the debate was the notion private hospitals, where those surgeons in private practice operate, can help reduce ballooning waiting lists at public hospitals.
The year before the report to King, the Government announced an extra $70m in funding for orthopaedic surgeries.
King told the Herald: “In 2004 we arranged for orthopaedics to be done in private, paid at the cost it would be in the public, to reduce waiting lists for orthopaedics and cataracts.
“That was a definite decision made by the [then] Prime Minister [Helen Clark] and me to reduce the number of people waiting for orthopaedic surgery.
“The really interesting thing about it was we got the orthopaedic surgeons to agree they could not charge any more than it would have cost to have done it in the public health system.”
At the time the Health Funds Association of New Zealand [HFANZ] said while $70m in four years seemed like a lot of money, anyone who thought it would provide more than a temporary respite to the fundamental and underlying problems faced by the public health system would be disappointed.
In April HFANZ chief executive Roger Styles said health insurers paid an unprecedented $1.322b in claims in the year to March, “reflecting the value of the private sector at a time surgeries in public hospitals have
been cut and waiting lists grow due to ongoing industrial action”.
Styles predicted elective surgery forecasts for the full 2018-19 year would miss their targets because, for the first year in more than a decade, volumes were down compared with the previous year.
An estimated 300,000 New Zealanders were waiting for elective surgery, according to a 2016 survey commissioned by HFANZ and the Private Surgical Hospitals Association, although around 170,000 of them were not officially recognised as being on waiting lists.
Back in 2005, HFANZ said successive Governments had failed to admit the public sector did not have the capacity to provide emergency services and undertake the quantum of elective surgery required.
“By failing to face up to this fact, despite evidence to the contrary, the public are misled into thinking the public health system will be there for them when they need it.”