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16 April 06
Waiting
for Help
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Emily,
like 180,000 or so other New Zealanders, is on a hospital
waiting list.
The
problem is this “queue” of people waiting for surgery is
no longer called a “waiting list”. It was changed when
lengthening hospital waiting lists became politically
embarrassing in the late nineties.
Growing
waiting lists are a symptom of a sick health system: a
“Schindler’s list” of 180,000 sick and dying people is
hardly the sort of image wanted by a government trying to
claim it is running a modern and effective health system!
Waiting
lists have now been replaced with a “tiered” booking and
management system. Patients needing non-urgent surgery are
referred to a specialist by their GP. They then join the
hundreds of thousands of patients waiting for a specialist
assessment. Once seen by the specialist, they will receive a
‘points’ score, which will either qualify them for the
hospital booking system, or they will remain under assessment
by the specialist or their GP until their condition
deteriorates to a stage that justifies surgery.
In
other words, the single old-fashioned waiting list has now
been replaced by a modern version - several separate waiting
lists operating at different levels of prioritization. At the
highest level are those patients who are booked in for surgery
with a date for their operation. Next are those who are booked
in but are still waiting for a date. Then, there are those
waiting to get onto the booking list, those waiting to be
assessed, and those waiting for their conditions to
deteriorate. But no matter what they want to call it, there
are still 180,000 people waiting for surgery.
Whether
or not Emily and others on the waiting list get their surgery
is determined by the policies of the 21 District Health
Boards, which operate between a rock and a hard place under
the directive of a Government that wants to pretend that there
is no hospital waiting list, only waiting times!
On
the one hand, Labour is requiring the DHBs to minimise their
budget deficits, while on the other hand it is imposing
massive cost pressures on the health system: under their
watch, there has been a dramatic expansion in the health
bureaucracy to the point where there are now an estimated
12,000 administrators for New Zealand’s 12,000 hospital
beds. Further, tens of millions of dollars are now being
poured into the administration of DHBs, Maori health units,
PHOs, and a massively expanded Ministry of Health, with
hundreds and hundreds of millions of dollars a year being
consumed in pay settlements and Holiday Act changes.
As
a result of this cost explosion, health funding
has increased from $6.6 billion a year when Labour took office
in 1999 to $10 billion today. Yet, in spite of that fifty per
cent increase in funding, there has only been an 8 per cent
increase in operations over that time, with elective surgery
numbers having risen from 99,000 to 107,000. This
means that over the last seven years the public health system
has become increasingly costly, focused on serving the
bureaucracy, rather than patients.
According
to a news report last month, Auckland Public Hospital now
charges about four times as much as the private Auckland based
Ascot Hospital for some identical services: a night in
intensive care at Auckland Hospital cost $3901, compared to
$929 at Ascot, and ambulance costs for Ascot were a flat $100,
compared to $600 for Auckland Hospital.
The
increasing cost of public health is one of the reasons why,
some years ago, ACC established a partnership with the private
sector. This has enabled ACC to not only significantly save
costs, but to also get procedures carried out in a timely
fashion: patients unable to return to work until they’d had
a minor operation used to have to wait on ACC for an average
of two years, but after the private hospital tendering system
was put in place, the average waiting list reduced to just 44
days.
As
a result of increased cost pressures, many DHBs are being
forced to raise their surgery eligibility thresholds in order
to reduce the number of patients who qualify for operations.
Some are even cutting their specialist assessment waiting
lists: Canterbury DHB has dropped over 2,500 patients from its
waiting list over the last year, with the Hawke’s Bay DHB
dropping 1800
in the last week (the performance of DHBs can be compared by
clicking here to view>>>).
This
could well be just be the tip of the iceberg as more and more
DHBs cut their lists to try to stay within budgets, forcing
their patients to have to become sicker and sicker before they
can qualify for an operation. This unsatisfactory state of
affairs has caused some community groups like the Northland
District RSA to establish a Cataract Project to help fund RSA
members who are stuck on hospital waiting lists, to get their
surgery done privately (click here to view
a description of the venture by the Trust Chairman, Marian
Barclay).
Some
Health Boards are also looking at providing subsidies to help
patients on their waiting lists - who realistically would not
qualify for surgery in the foreseeable future - go private,
with the Hutt Valley DHB
investigating a plan to pay up to 30 per cent of the private
surgery costs for some of its patients.
Waiting
lists for elective surgery are a key concern for DHBs
nationwide as they struggle to manage demand for services
within tight budgets. But
putting patients at risk, by not treating them in a timely
fashion, is not only inhuman, but it can also be the cause of
dramatic cost increases as well.
Take
eighty-five year old Emily: all she needed
was to have her cataracts removed, to reverse her
deteriorating vision. However, as a result of her impaired
ability to judge distances, she ended up having a fall. While
bones were not broken, she had to be taken to accident and
emergency, has needed weeks of rest-home care, hospital
rehabilitation, some home modifications, on-going home-based
nursing care - and the cataracts still need to be removed!
Something
that should have been a simple $2,000 procedure (click here to
view
surgical cost estimates>>>) will end up having cost
many tens of thousands of dollars, not to mention all the
distress and suffering. Surely our public health system can do
better than this?
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This
weeks poll.
The
poll this week asks whether you would like to see District
Health Boards reduce their hospital waiting lists by making
greater use of the private sector? To take part in our online poll
>>>
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