The government’s focus on elective surgery wait times has driven thousands of outsourced operations – and fresh warnings about the risks of draining public sector expertise, writes Catherine McGregor in today’s extract from The Bulletin.
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Health targets to be enshrined in law
The government has unveiled sweeping amendments to the Pae Ora (Healthy Futures) Act, the 2022 law that dissolved district health boards in favour of a national system, RNZ reports. Health minister Simeon Brown says that “after years of bureaucracy and confusion, the health system lost its focus”, and the amendments will help anchor patient outcomes at the heart of decision-making. Under the changes, infrastructure delivery will become a core statutory function of Health New Zealand, and oversight of Hauora Māori structures will be clarified. Perhaps most importantly, the national health targets – which were scrapped by Labour in 2018 before being resurrected by the coalition – will be put into law.
Outsourcing to meet surgical goals
To help hit the target of 95% of elective surgeries delivered within four months by 2030, the government last week announced it had funded nearly 10,000 extra procedures since January – most of them through private hospitals. Health NZ’s plan is to outsource up to 20,000 low-complexity cases such as hip replacements, cataracts and hernias.
What may be good news for suffering patients is bad news for the public health system, many medical staff say. Last month RNZ reported on a Health NZ memo to the minister warning that the high level of outsourcing would hasten an exodus of medical professionals from the public system. Speaking to Morning Report, Auckland radiologist Colleen Bergin echoed that sentiment. “This will send the workforce into private. The pay is better, the parking is better, the transport is better, everything is better.”
Meanwhile anaesthetists warned that siphoning off low-complexity surgeries could dramatically slow the rate at which trainees accrue the requisite number of training hours, and there’s currently no system in place to have them train in private hospitals.
Who really benefits from outsourcing?
While outsourcing may bring quick wins on the government’s elective surgery scoreboard, critics argue it’s worsening the core problems. Writing in Newsroom, Ian Powell, former head of the Association of Salaried Specialists, says the approach ignores the main pressure point – chronic workforce shortages – while pumping taxpayer funds into for-profit hospitals and incentivising top specialists to shift their hours into the private sector.
In some cases, surgeons and anaesthetists are now being paid thousands per shift to take on extra weekend work through in-sourcing arrangements in their own public hospitals. “It beggars belief how much cash is being thrown around,” one anaesthetist, told Powell, who found that some in the sector could earn up to $15,000 for a single day as a private contractor. Powell argues the result is a system in which public hospitals are left with the more difficult cases and less capacity to treat them.
Primary care ‘second among equals’
While hospitals and wait times dominate headlines, the primary care sector remains underfunded and politically sidelined, GPs say. A recent study showed that despite years of political rhetoric about its importance, primary care has received a flat share of the health budget – just 5.4% on average over the past 15 years, far below the OECD average. Speaking to Mariné Lourens in The Press (paywalled), Christchurch GP Buzz Burrell said the visibility of hospital wins makes them more attractive to ministers. “It looks good if they fund a raft of very expensive drugs. It looks good if they fund more surgeries.” In contrast, “if primary care is doing its job brilliantly, it’s invisible.”
Asked to respond, the health minister said primary care was a “key priority”, pointing to recent announcements including new clinical placements for overseas-trained doctors to work in primary care, extra doctor training places at medical schools and a new 24-hour telehealth service.
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