Keeping patients waiting pays off for hospitals

Hospital emergency departments are getting more money the longer patients are kept waiting.

If a patient is in accident and emergency for more than three hours, the amount the hospital gets from its district health board is three times the amount it gets for a shorter visit, the Herald has learned.

Major trauma centres such as those at Auckland City and Waikato hospitals are believed to receive about $200 for each patient who comes through the door, but that increases to about $600 after three hours.

The funding quirk is unlikely to prolong waiting times artificially, say health professionals.

Waitemata District Health Board chief executive Dr Dwayne Crombie said: "I don't think it drives their behaviour, but it certainly makes you wonder."

North Shore Hospital receives on average $140 from the health board for every patient who comes into the emergency department. That increases to $554 if the patient is there for more than three hours.

The hospital receives more than $1000 if the patient is admitted, said Dr Crombie.

These payments include diagnostic costs such as scans.

"That's why it seems a big number ... A lot of that jump in price is the theory that the longer you spend in the emergency department, the more investigations you're having."

Waikato District Health Board spokesman Philip Renner said its payments began only when people started being assessed. The hospital got $220 if treatment took less than three hours. If the treatment was likely to take longer, the patient was sent to the acute assessment unit, for which the hospital got around $600 from the health board.

"If we didn't put them into the acute assessment unit, 95 per cent of those cases would have been admitted to the ward," said Mr Renner. Ward admissions cost the health board around $1300.

"By having that middle structure we actually save money in the long run."

Auckland District Health Board said the figures were national averages, but could not provide its own figures.

Counties Manukau District Health Board has chosen not to fund its emergency departments this way. Acute care service manager Dot McKeen said the department got a yearly budget based on expected demand.

The Ministry of Health denied having a per-patient fixed-price method for funding emergency departments.

It issued a statement in response to the Herald's questions.

"While there is no national price for a district health board's own population, a national price has been agreed for where DHBs treat patients from another DHB's area."

It said when a patient was treated for more than three hours or had a general anaesthetic, he or she was considered to have been admitted.

"The cost of the emergency department part of the treatment is then combined with any other costs they accrue as a part of their in-patient stay."

Occasionally patients are kept for longer than three hours for observation.

"The national emergency department price reflects the average costs of all patients treated within three hours plus those 'observed'.

"There is no one in-patient price as each price reflects the particular range of services provided to the patient."