KEY POINTS:
Some district health boards do not have the capacity to cope with increased state funding for elective surgery and are contracting out much of the extra work to private hospitals.
"This year we will subcontract about 14 per cent of our elective work to the private sector," Counties Manukau chief operating officer Ron Dunham said yesterday.
"That is about 1800 patients and will cost us about $6.6 million."
A year ago the board was contracting out about 11 per cent.
The Government announced an extra $60 million a year for elective services in 2006, to increase the number of patients treated by 10 per cent; tomorrow's Budget will add $35 million more a year.
The Waitemata board's share of the 2006 fund is $7.12 million this financial year. In the past 10 months, it has spent $3.12 million of this on private hospital care, including joint replacements, gynaecology and general surgery.
After the new money started flowing, a board paper said that because of "constraints on inpatient beds within North Shore and Waitakere Hospital" the best way to deliver most of the extra services would be through private hospital contracting.
The Auckland DHB expects to buy $8.6 million or nearly 8 per cent of its $112 million of elective surgery from private hospitals this financial year. Nearly $3.5 million will go on cardiothoracic surgery, up from $1.7 million in 2006/7.
The senior doctors' union's preference is for public hospitals to build their own capacity, partly because recruiting surgeons to the public sector could become more difficult if their mix of work shifts towards more complex acute work and fewer elective patients.
Union president Dr Jeff Brown said public hospitals also relied on elective surgery to cross-subsidise costly acute work.
Health Minister David Cunliffe said he had no problem with health boards contracting electives to private hospitals, but would be concerned at a trend of increasing reliance on this.
About 3 per cent of publicly funded elective surgery discharges were carried out in the private sector, he said.
"The first priority is to have a public sector that delivers efficient, accessible and safe services and I believe we are achieving this.
"I have asked the Ministry of Health to work with all DHBs to ensure the sharing of best practice and structure of capacity constraints. Use of private facilities should be a short term flow enhancement rather than structural component."
Mr Dunham said Counties would cut private contracting from July. The majority of the new work to be funded from the extra dollars in tomorrow's Budget would be done in-house.
The chief executive of private hospitals owner Southern Cross Healthcare, Ian McPherson, said it had done about $4.5 million of work for Auckland boards in the past 10 months, a similar amount to last year but more than in 2005/6.
It had also turned down work offered at short notice because it did not have sufficient capacity, but could have accepted it if asked earlier.
"That's a frustration. We would be able to give a better deal if this was planned in future. We would be able to do more if there was going to be a guaranteed revenue stream to match our investments," he said.
