Date Published: 13 May 2009
Time to revisit fairness in NZ health system
Private surgery system works against the poor, study shows.
High rates of private surgery have not led to a corresponding increase in access to public surgery - despite a more than decade-long effort to improve fairness in the New Zealand public health system, University of Otago research shows.
The paper, recently published in the International Journal of Health Planning and Management, found that people living in areas with greater private surgery available had less access to public surgery, according to co-author Dr Sarah Derrett.
"It is worrying that we found provision of private surgery did not increase access to the public system. Instead we found the opposite - that areas of New Zealand with more private surgery had worse access to public surgery," says Dr Derrett.
"But of greatest concern, is that even for the poorest people in our communities, access to the public sector was no better in regions with high private surgery."
A prioritisation system was introduced to the public health system in 1996 to improve fairness of access to surgery both geographically and in terms of patients' health needs. However, researchers found that the likelihood of having elective surgery continued to vary widely according to where people live, and also allows surgery for those who can afford to pay (out-of-pocket or through medical insurance) regardless of their health need.
Dr Derrett, along with co-authors Mrs Tui Bevin, Associate Professor Peter Herbison and Professor Charlotte Paul from the Dunedin School of Medicine at the University of Otago, looked at surgery for elective hip/knee joint replacement, prostatectomy and cataract surgery over a five-year period from 2000 to 2005.
Rates of access to publicly-funded surgery in some District Health Boards (DHBs) were five times greater than rates in other DHBs. Even among the largest DHBs, rates varied by as much as two-and-a-half times.
Furthermore, the availability of private surgery did not improve access to public surgery. It is sometimes assumed that the provision of private surgery will improve access to publicly funded surgery; particularly for the poorest New Zealanders who are unable to pay for private surgery. However, the paper reported that high private surgery was not associated with improved access to public surgery.
"Clearly, New Zealanders need to revisit the issue of fairness in our health system," concludes Dr Derrett. "Our research shows that access by the wealthy can adversely affect access for the poorest among us. Recent calls encouraging the promotion of medical tourism in New Zealand should be treated with great caution until we have better understanding of the reasons why the private surgery system works against the public."