Patients told: Get insurance

Patients referred to the Waitemata District Health Board for sterilisation, orthopaedic care or with gallbladder trouble are among those less likely to receive surgery, as healthcare rationing is tightened.

Some Waitemata doctors are urging patients to take out health insurance if they can afford it because the public system can no longer help them with minor conditions.

Board chief executive Dwayne Crombie has said the access "bar" for elective services - specialist assessments and treatment - has risen progressively in the past five years, largely because the district's rapidly ageing population is stretching services beyond funding increases.

And the bar will rise again as part of the board's response to a Health Ministry demand to deal with the nearly 3000 patients waiting for more than six months for a first specialist assessment or treatment.

Dr Crombie said staff would review the referrals of people waiting too long to enter the public health system. Some would no longer need to see a specialist, some could be managed by a GP and some could be treated without surgery.

"Part of it is getting advice to GPs about how they can manage conditions [for which patients] don't need to see a specialist, for example minor incontinence."

Women referred for sterilisation could often more appropriately have a Mirena contraceptive-drug-releasing device put in their uterus as an alternative to hysterectomy or tubal ligation surgery (although women's health groups say the device is not suitable for all women).

He said Waitemata was doing much more elective surgery than last year, but he also acknowledged that more and more "elective" surgery - sometimes referred to as non-urgent - was in fact semi-acute.

Gallbladder removal surgery was an example.

"You've got to be in pain and have acute symptoms to get higher up the list."

A Waitemata doctor, who declined to be named, was unaware of any gallbladder patients being treated from the waiting list now.

"The ones that are really inflamed, that won't get better, that are really sick, they get done acutely."

The orthopaedics clinical director at the board's North Shore Hospital, Dr John Cullen, said it was doing many more hip and knee replacement operations in a special Government project.

But he was concerned at having to send back to their GPs 100 of the 300 patients referred each month for assessment by an orthopaedic surgeon.

Some would benefit from surgery. One recently rejected patient in this category had a swelling on the foot pressing on a nerve, causing pain. The swelling needed to be removed, he said.

The unnamed doctor and Dr Cullen - who does not work in the private sector - said people should take out health insurance if they could afford to.

The amount of money in health was not going to cater for everybody.