24 Mar 2017

'Damning picture of unmet health need' - researcher

1:50 pm on 24 March 2017

Researchers are calling for more data on community health, with one study revealing widespread unmet health needs and another showing large numbers of surgery patients being turned away.

Doctor, nurse of other health worker filling out medical form

Photo: 123RF

The Health Ministry began measuring the hotly debated unmet need for non-urgent healthcare over a year ago, but doctors say it does not include those who are not referred to hospitals for treatment because their GP knows it will not be accepted, and those referred and declined.

A pilot study based in Auckland and Christchurch published in the New Zealand Medical Journal today, found 25 percent of respondents could not afford a GP and a further 9 percent went without hospital care they needed.

Lead researcher and surgeon Phil Bagshaw said the new pilot study showed 300,000 adults were in that predicament.

"There are a lot of people now who have needs. They're not recorded anywhere.

"At least when we had waiting lists there was a record of who was needing treatment. But now of course with this National Waiting Time Project, if you don't meet the criteria your need is not recorded anywhere."

"We do need now to do a proper national study which would involve sampling somewhere around 11,000 people, and would cost close to three quarters of a million dollars, but we have to do that because the longer we leave it, the more it's going to cost.

He said the study showed a damning picture of unmet health need in the community.

He said the pilot paved the way for a full national survery.

"I think it's going to show that a lot of people live with disabilities from treatable disease, which is not a good thing for two reasons. Firstly it's inhumane, but secondly it does not make economic sense."

Professor Bagshaw said more transparency was urgently needed on the topic, and doctors would not be happy until they had a full and independent assessment.

"I have the group, the expert group, that can do it. We have the tool, we've refined the tool. It's taken a lot of time to do, but we are determined that we are going to use it, and the group that I'm leading I'm sure will not be happy until this has been completed."

He said waiting lists, which have been abolished, at least provided some information about the numbers needing care.

"With the waiting list it was bad that people waited, but we did have a record that there was this group of people needing treatment."

The study's researchers said a full national survery would offer participants face-to-face or phone interviews.

GPs would not be involved because the pilot had shown they were too busy to handle the extra paperwork.

"They don't have time and they know it won't make any difference anyway so why do it," Prof Bagshaw said.

However, there was debate among doctors about the true level of unmet need for care, both in hospitals and the community.

Prof Bagshaw said that could be expected in an era of greater transparency about most things.

"This is an area which is completely and utterly unknown, and about which there are very strong opinions on both sides, and I think you know both sides can't be right here. If it's as big as we think it is then something important must be done about it."

Prof Bagshaw said other countries measured unmet need and New Zealand should too.

He said more than 11,000 people would need to be interviewed over a period of about six months by independent researchers.

He estimated it would cost about $750,000, a cost he expected to be met by charity and donations.

Mr Bagshaw's comments came on the same day as another study in the Journal, which found that over eight months about half of patients for hip and knee osteoarthritis were being turned away.

Of the more than 1700 patients referred for specialist assessment for surgery at Christchurch Hospital over the 8 months in 2015 and 2016, 43 percent of hip patients and 54 percent of knee patients were declined.

That study's lead author, Gary Hooper, said the rate had decline since then to about a third, but that was still high numbers being turned away and it was hard on patients.

Prof Hooper said the patients had been refused under a triage process that allowed clinicians to balance demand against a government requirement that those accepted are seen quickly.

"Any doctor who sees a patient suffering with the disabling pain secondary to osteoarthritis would concurr.

"Unfortunately, it's the reality of our health setting and it's the reality of the money that we've got to spend on these types of conditions within the public hospital.

He said low capacity was behind the high rates.