The following is a letter sent to a number of politicians in the health sector by Alan Gray and Brian Easton
Keywords: Health;
The current amendments to the ACC legislation, which were introduced to the House on 2 August 2004, are a real improvement, & seem widely supported.
However, they continue an anomaly which Sue Bradford referred to in her speech on 5 August 2004 in which she stated that the Green Party were supportive of the Bill in general but had some areas of concern which she hoped would be dealt with in the Select Committee process.
In her speech she stated-
“There is a proposition within the bill that will exclude from cover personal injury that is solely attributable to a resource allocation decision. To give one example of what this might mean, it could be applied to someone who is denied ACC cover where the recurrence of metastatic cancer that is caused by delays in provision of radiation therapy for primary cancer occurs solely because there are not enough radiation therapists or equipment to carry out the treatment in a timely manner. Unfortunately, this is a very real kind of situation in New Zealand at present and we would like to see the bill amended to remove this exclusion, at least for injuries which are of such severity that they currently qualify as a medical mishap. For example, causing death, hospitalisation for more than 14 days or significant disability for more than 28 days. [Our emphasis].
In fact, section 33[4] of the Injury Prevention, Rehabilitation and Compensation Act states that – “medical error” does not exist solely because desired results are not achieved, subsequent events show that different decisions might have produced better results, or the failure in question consists of a delay or failure attributable to the resource allocation decisions of the organisation .[Our emphasis]
It seems therefore that while health professionals can commit errors, the organisation cannot!
Although the public rhetoric is in terms of ‘waiting lists’, the issue is really the time a person has to wait between the medical decision to treat and the treatment itself.
Waiting times cannot be shortened overnight, but a campaign to shorten the significant ones over a period can be implemented so they at least fall within the waiting times guidelines. What is proposed here is to systematise the process in the following five steps.
1. A Census of Waiting Times. Each hospital should report annually its typical waiting time for each treatment, alongside the guidelines for each type of treatment.
2. An evaluation by clinicians and economists of the social costs of the waiting times. (This is necessary for stage 4).
3. The government should set aside a substantial amount each year, say, $60million (or some fiscally prudent sum), and invite hospitals to tender for amounts to enable it to shorten its waiting times to within the guidelines.
4. The sums allocated would aim to maximise the reduction in social costs.
5. Successful tenderer’s would agree to maintain from their own resources, waiting times to the agreed level thereafter.
What is being proposed here is not very different from the roading strategy, where the government is finding additional funds to catch-up for the backlog of congested roads.
Because it is a fixed amount which is tendered for, the fiscal risk is largely confined to the alternate uses the funds could be put to. There is also a minor fiscal risk if those who avoid the waiting lists by purchasing their treatment privately (often with medical insurance) switch back into the public health system.
The political risk would be to do step 1, without thoroughly anchoring it into steps 2-5, so that there is a clamour over the waiting times, but the public does not think anything is getting done.
Waiting times have served their purpose, & every effort should be made to abolish them. The current stricter criteria for acceptance on to the list, & the greater accountability of health professionals in the system, has not been followed by sufficient resources to deal with the problem [Although the variation between hospitals suggest there are major management problems contributing to them as well].
The present ACC amendment bill could serve as a stimulus for the Government to revisit the problem, develop a much more aggressive strategy for dealing with waiting times, & allow ACC to act as a spur to hospital management to improve their performance
Such a bold approach would demonstrate the Government means business in providing an efficient health service.
We would be pleased to discuss this further with you if you wish.
Yours sincerely,
Alan Gray and Brian Easton
A paper, The Gains From Reducing Waiting Times, shows the high value of eliminating excess waiting time backlogs.