Aucklanders miss out on healthcare
Hospital bosses say more and more outside the region are accessing services, writes Nicholas Jones
Aucklanders are missing out on healthcare because they are effectively subsidising treatment for people living outside the city, hospital bosses say. However, with health boards across the country in deficit the Ministry of Health has told Auckland DHB the funding won’t change.
The country’s 20 district health boards are funded to treat people living within their boundaries. When someone living in another area is treated — such as a person showing up in ED — their DHB must pay for the treatment given.
Auckland DHB relies on these payments more than most, as a major centre and because it provides specialised treatment and surgery that isn’t available in other areas. About half of its hospital services are delivered to people outside its borders.
The funding was discussed at a recent board meeting. Chief executive Ailsa Claire told members that 50 per cent of the service provided to nonresidents wasn’t priced correctly and, “therefore, the Auckland population has been cross subsidising the rest of the country”.
According to minutes from the meeting, board chairman Pat Snedden said the situation meant “the Auckland local population misses out, which is not fair”.
“However, the Government has determined that as all DHBs are in deficit, to ask for more from them is not seen as sustainable in the overall health funding scenario.
“There needs to be a reset in the technical pricing differential, but in the meantime we are instructed to be as efficient as we can with what we have.”
The worry about funding at the December meeting will have only increased, after the recent arrival of Covid-19. Hospitals are braced for the possibility of a large number of people needing urgent care, and in winter when they are already at capacity.
Asked what patients were missing out on, an Auckland DHB spokeswoman said Snedden was talking about community health initiatives.
“What our chairperson is referring
Fifty per cent of the service provided to nonresidents [isn’t] priced correctly and, therefore, the Auckland population has been cross subsidising the rest of the country.
Ailsa Claire (above), Auckland DHB
to in the minutes is our ambition to invest more in equity of outcomes and preventative care to keep people healthy in the community. This is a challenge when balancing spending on hospital care, but we are ambitious to increase investment in these areas.
“Our board, committees and leadership team are in regular discussion about this balance. No government can afford to fund everything they want to, therefore funding priorities and where they sit are a mixture of government priorities and what is negotiated with each individual DHB, and Auckland DHB is no exception.
“When you provide high-end specialist services for people who live outside of a DHB area, there is always a tension around pricing and costs . . . we are proud of the care we provide to all patients, wherever they reside.”
The Auckland region has three DHBs — Auckland serves central suburbs , Waitemata¯ covers west and northern areas, and Counties Manukau in the south, including Pakuranga.
Last year the Herald revealed ADHB raised serious concerns with the Ministry of Health about women living outside its boundaries using its facilities for booked inductions and caesarean sections.
The DHB briefed ministry officials on the numbers of non-resident women using secondary birthing facilities — between about a third and 50 per cent on any given day.
“Auckland DHB has a duty of care to its resident population and also to provide a safe and sustainable working environment for its employees,” a ministry official later summarised. “They know they cannot do that if a third of the people are coming from elsewhere.”
How DHBs work together and whether some could be merged is expected to be addressed in a sweeping, Government-commissioned review into the whole health and disability sector. Recommendations from the review are expected this month.