Public Cataract Operations
Why the Public System Contracting of Cataract Operations to Private Practitioners Continues to Maximise the Value of the Health Dollar.
The last decade has seen vast increases in public health funding, which are to be commended. However, these increases in funding have not necessarily translated to an improved service. A lack of proper infrastructure, resources and frameworks has meant that the taxpayer may not always get value for money. If the public health system is to become truly efficient and forward thinking, it must continue to further outsource contracts to the private sector. Having performed public cataract operations in private practice at Eye Institute as part of contracts with various DHBs, I have seen firsthand that outsourcing provides excellent value for the health dollar and more importantly, it means that patients’ needs are comprehensively and timely addressed.
A public health system that outsources more surgeries is a system that is more flexible and more resilient to changing health needs. From our contracting experience at Eye Institute in South Auckland I have seen that flexibility is something that is in short supply in the provision of cataract surgery. As several public centres have not been able to meet the required number of cataract surgeries that they were contracted to do, there has been mention of a reduction in the number of cataract surgeries performed. Yet while the lack of patients on waiting lists may seem cause for this change, the situation tells a different story.
Whether for a lack of awareness or for economic reasons, a high proportion of the population who have cataracts are not getting into a clinic. Due to the pressure to complete cataract surgery contracts within a certain period, surgeons may be going back to patients who have less of an urgency to have surgery, as it is more time efficient than searching for new patients with more severe conditions. The target service level is not too high; the initiative has simply not found all the patients who need the service. This means that patients who really need the surgery are not getting it, while those who could wait, get surgery first. And the taxpayer is not getting value for his health dollar either.
The system as it currently stands cannot be maintained in the long term. In order to create a robust, sustainable framework, investment must be made in infrastructure. Public funds should be directed at increasing the number of surgeons and the amount of theatre time allocated. They should not simply pay for more cataract operations. Improving infrastructure is, however, a difficult, long-term project. As the critical workforce becomes increasingly scarce, our ability to hire extra staff is compromised. In tough economic times, increasing capacity and increasing spending are not always viable options.
Improvements in infrastructure must be accompanied by an increased use of outsourcing to private practitioners. This is the only viable solution for alleviating the situation in the short term but outsourcing should also become an intrinsic part of the system in the long term. If the public health system outsources some it its operations, it does not have to spend any extra money. Instead, it will be making use of resources – of Surgeons, Optometrists and GPs – that already exist in our communities and who have a high level of professional expertise and experience. The DHBs’ lack of theatre time will be mitigated, and other operations will not be compromised. This would reconcile the levels of prioritisation: ‘acute’ surgery would be dealt with in-house, while more ‘elective’ surgery, such as cataract surgery, could be undertaken by the private sector. Necessary outcomes can be achieved without spending so much on building more theatre space, employing more nursing staff and increasing administrative overheads.
Many DHBs have relied on private practitioners, but they have done so in an ad-hoc way. Private provision should be part of the system, not a last-minute measure that is the result of desperation.
* Dr Nick Mantell MBChB, FRANZCO is an Eye Surgeon and Cataract Specialist at Eye Institute
top
