1. By the community; for the community Health Funding Crisis Forum
Canterbury Charity Hospital Trust & Unmet Need for Secondary Healthcare Services
By the community; for the community
Phil Bagshaw
Chair, CCHT
Health Funding Crisis Forum
1st July 2017

2. NZ Health Reforms & Healthcare Rationing
Core Services Committee 1992.
National Waiting Time Project 1998.
By September 2006:
24,000 patients refused FSA
22,000 taken off waiting lists
Result Increasing unmet need
Sharon Crosbie
The NZ Health Reforms of the 1990s have had many effects on our universal access, Public Health System.
The National Waiting Time Project (NWTP) had one of the largest effects.
Its objective was to control demand for free elective surgical services by removing patients from waiting lists, and only allowing them onto waiting lists if their operations could be done within 6 months.
By September 2006, Canterbury DBH had refused 24,000 patients an initial specialist assessment for elective surgery at public hospitals; and removed 22,000 patients from the elective surgery waiting lists.
Official data on the effects of the NWTP were only kept by the CDHB until September 2006.
The results of the NWTP have varied around NZ, but there has undoubtedly been a large increase in the amount of unmet need for elective surgery.

3. Acceptance Pipeline for Public Hospital Elective Healthcare
Disease
Reservoir of Community Need
Reservoir of Community Need
Community Expectations
GP Expectations
‘Health Pathways’
Clinical/Financial Priority Thresholds
National Waiting Time Standards
The hateful metaphor
“..... altering the trajectory of demand”
First Specialist Assessment
Accepted for Treatment

5. National Studies of Unmet Need for General Hospital Healthcare Services
Canada & USA
Italy
Thailand
Sierra Leone

6. Apart from adults who get surgery each year:-
How much unmet need for non-urgent surgery is there?
Apart from adults who get surgery each year:-
Another 280,000/yr told they need surgery
Of these:170,000 aren’t recorded anywhere
Survey criticized by Minister of Health.

7. STAGE 1: Pilot Study of Methods to Measure Unmet Secondary (Hospital) Healthcare Need in Adults
Investigators
A Prof Phil Bagshaw *†
Dr Sue Bagshaw *†
Prof Chris Frampton *
Prof Robin Gauld **
Dr Terri Green §
Prof Andrew Hornblow §
Dr Ben Hudson *
Dr Antony Raymont ¶
Prof Ann Richardson §
Prof Les Toop *
Mr Carl Shaw †
* University of Otago, ChCh; ** University of Otago, Dunedin; § University of Canterbury; ¶ Auckland Independent Heath Researcher; † Canterbury Charity Hospital Trust, ChCh

8. Methods (n = 1,277; Q23) Christchurch & Auckland regions:
1. GP recorded cases as seen
2. Random people sampled by:
Face-to-face interviews
Telephone interviews
Online survey

9. Results Primary (GP) Healthcare – because of cost:
16.5% missed GP visits
4.9% didn’t fill prescriptions
11.4% missed tests, treatments or follow-ups
Secondary (Hospital) Healthcare
9.3% reported unmet need recommended by health professional (Quality about 300,000)

10. Types of Unmet Hospital Healthcare Needs
Medical consultations
Orthopaedic operations
Surgical consultations
General Surgery operations
Dental
consultations
Colonoscopy
Gastroscopy
Psychiatric consultations
Other procedures

11. STAGE 2: Independent National Survey of Unmet Hospital Healthcare Need
Larger, even more expert panel
Aim: Survey with power to measure quantity & type of unmet need by: ethnicity, income group, region, etc
Question 12,000 by face-to-face or telephone questionnaire
Cost $1.2m – current HRC application

12. Stage 3 INDEPENDENT national survey by panel of experts every 2 years
To inform public on performance of hospital healthcare system
To inform decisions by policy makers & planners

13. John Donne (1572 - 1631) Why bother
John Donne ( ) Why bother? - Devotions upon Emergent Occasions; Meditation XVII
"No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; ……… any mans death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee."