ACC and Elective Surgery
AUTHOR: Peter Dunne
I wrote this thinkpiece for the National Business Review, which published it on 23 October 2009:
The emerging debate about the ACC scheme presents an opportunity to take a bolder and more lateral approach to the future provision of healthcare services in New Zealand.
Leaving to one side for the moment the philosophical arguments about whether ACC is effectively a form of social insurance or a comprehensive taxpayer funded scheme, the fact remains that it has been very successful at using its collective purchasing power to provide a wide range of services to the victims of accidents. This is an aspect of ACC that deserves far greater attention in the current review, as it has the potential to bring about far more significant patient gains overall.
Elective surgery waiting times in New Zealand are currently unacceptably high – at a minimum, twice as long as in Britain, and almost three times longer than waiting times in Holland and Spain. At the same time, there is significant under utilised capacity in our private surgical hospital sector. For its part, ACC has already developed a successful model of tendering various services to private providers. The current review presents the opportunity to expand this aspect of ACC services, to make a real, sustainable and permanent impact on elective surgery waiting times.
While the traditional “cradle to the grave” approach of the public health system in New Zealand makes it difficult to immediately shift to a system akin to that in Holland, based solely on public insurance, there is nevertheless the opportunity to consider some form of mandatory levy for non-acute secondary treatment, enabling the more effective use of public and private surgical facilities to bring down waiting times.
A starting point could be to expand the existing ACC framework to cover a range of procedures (for example, hips, knees, cataracts, angioplasty) for patients over the age of 65 years. That would need to be accompanied by a specific policy requirement that those procedures be provided within a specified time frame (initially, say, six months, reducing to three months and below). Both the range of services and the age cohorts covered could be expanded over time, with the ultimate aim being a comprehensive national service for all New Zealanders. At the same time, as a transitional move, existing private health insurance provision could be encouraged by the introduction of tax deductibility for health insurance premia, again starting with those 65 and over, who currently face the greatest difficulty keeping up their payments, at the very time they need the cover provided most.
Around the world, governments of all philosophical hues are grappling with the increasing costs and demands of healthcare, and their own diminishing resource bases. New Zealand is no different. Our ACC system is regarded as world class, and the current review provides the chance for an innovative approach that not only secures the future of ACC, but also ensures that New Zealanders have access to high quality healthcare services.