Health Reforms Raise Fears Of Two-Tier System And Workforce Shortages
Moves by Health NZ to outsource elective operations to the private hospital sector increase the risk of a two-tier health system and will worsen the medical workforce shortage, a leading medical college has warned.
The Australian and New Zealand College of Anaesthetists (ANZCA) is one of the largest specialist medical colleges in Australia and New Zealand and the region's leading authority on anaesthesia, pain medicine and perioperative medicine.
Dr Graham Roper, chair of ANZCA's New Zealand National Committee, says the outsourcing plans will negatively affect the training of anaesthetists, who are critical for operations to proceed, and see existing specialists move from public hospitals to the private sector.
'Trainees' practical experience will be impacted, with a loss of exposure to outsourced clinical cases, and skewed amounts of urgent and complex work. It will take longer for trainees to get their required experience, delaying their entry into the workforce. Anaesthesia training will become less desirable, threatening the ability to produce much-needed specialists.
'Anaesthetists are a central part of both the hospital and the surgical team – without them, operations simply can't go ahead.'
Dr Roper says the changes will lead to public system specialists facing a large amount of complex and urgent patients, requiring the highest level of care with extended hours of work. This would lead to specialists choosing to move to the private sector, further increasing the strain on the public system.
He is also questioning the ability of some private facilities to provide the required level of care and training opportunities.
'Not all private facilities are set up to deliver the same level of clinical care as the public system. Private providers do not take on the same complexity of work in the same volumes as the public system, and may not provide high-dependency care, intensive care, acute pain services, pre-admission clinics and access to urgent investigations. Any significant complications during or after surgery will see the patient transferred to the public system for ongoing care.
'Many private facilities do not have on-site medical cover overnight and have a limited ability to respond to medical emergencies,' Dr Roper says.
'Our Māori and Pacific peoples, with increased complexity of health needs, are unlikely to benefit from this outsourcing model. In addition, our rural and remote communities may not be well served with this change.
'People living in rural areas are not always close to a private provider, can have transport difficulties, and lose family and whānau support if they have to travel long distances for surgery.'
Dr Roper says ANZCA is willing to be involved in finding solutions to the unmet need of elective surgery across Aotearoa New Zealand.
'The provision of high-quality safe and equitable care for our community remains the core aim of our profession and the New Zealand public should expect that access to anaesthesia and surgery is future-proofed.'
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