 Latest News. 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.
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