 Latest News. The need for an integrated health system to cope with the rise in cataract surgery.
With an aging population, it is well recognised
that the demand for state funded healthcare will
be under increasing pressure. For example, take
cataract surgery, the demand for cataract surgery in
the greater Auckland area is steadily growing. This presents not
only cost issues, but issues around access and public awareness
regarding the surgical options for cataracts.
Cataract waiting lists only represent the cross section of the
population; those who have been seen in clinics. Many with
cataracts are still waiting to be seen in clinic, while others are
not aware of the options available to them. I make this point
having recently completed a public cataract contract for Counties
Manukau DHB. Five out of ten of these patients operated on,
had severe cataracts that were significantly impairing even their
simple normal daily tasks. These types of cases one would expect
to see in less developed countries.
Cataracts don’t cause permanent damage, but the fact is that
there is significant morbidity for people who have cataracts.
Surgery has come a long way in two decades. Patients had to wait
till they were near a state of blindness before surgery, recovery
was lengthy and most patients required significant spectacle
correction. Today it’s general practice to advise that cataracts be
removed as soon as they cause early significant symptoms, as the
benefits outweigh the small risks of surgery. Distance vision and
spectacle dependence can also be reduced with minimal unwanted
side effects.
In the December issue of NZ Optics, I raised the issue of the
public system’s need to expand infrastructure and services to cope
with the numbers growing on waiting lists. In ten years there
have been no additional public eye theatres built in the Auckland
area, so it is encouraging to see that the National government is
now looking to provide 20 new operating theatres dedicated to
elective surgery to reduce waiting lists. Any extra funding for the
rise in cataract numbers will mean greater patient numbers being
operated on. It will take time for these facilities to be built and
commissioned.
In the meantime medium term planning is required to provide
the public with equitable access to cataract surgery. With the
current infrastructure, flexible initiatives like integrated health
care from public and private care providers is the way forward.
Contracting cataract surgeries to private providers allows DHBs
to increase cataract numbers and ease the pressure off public
theatres, thereby freeing up room for more complex eye cases to
be performed in public. Two points to make are, firstly, cataract
contracts should not be performed at the expense of other
surgeries. Secondly, most surgeons involved in these contracts
are doing them at a price which doesn’t leave the hospitals out
of pocket for each surgery, and the margins are low compared to
private cataract surgery.
With initiatives around the provision of more adequate cataract
services, access and the issues around facilities, staffing and
funding clinics can be addressed. The public and private sector
now need to plan to work togeather to shorten waiting lists, ease
pressure off the public system and manage care for those baby
boomers likely to face cataract removal.
*Dr Nick Mantell is an Eye Surgeon and Cataract Specialist, MBChB,
FRANZCO at Eye Institute.
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