Otago has the country's highest rate of grommet insertion - a
procedure in the sights of a Government health committee
tasked with finding savings in the health sector.
The National Health Committee has suggested possible annual
savings of $4.4 million through inserting fewer grommets,
which are tiny ventilation tubes inserted into the eardrum,
used to treat glue ear. Since it was revealed this month, the
committee has emphasised its proposal is at a very early
Dunedin Hospital ear, nose, and throat specialist Martyn
Fields said it was unclear why Otago had the highest grommet
rate, and Southland the third highest. Ministry of Health
data shows Otago's standardised discharge ratio in 2010-11 of
1.84 for grommet surgery was the country's highest.
North Island boards did fewer procedures than South Island
boards, with Hawkes Bay doing the least, with a 0.59
standardised discharge ratio. Mr Fields said glue ear was not
over-treated in the South.
''I send back at least half of the children I see [for ear
infections], as they do not meet departmental guidelines to
''For every child who gets referred in with ear infection
problems, probably less than a third end up with grommets.
''We're not offering surgery to every child who walks through
the door - we do know that there's a finite amount of money,
and try and target those most in need,'' Mr Fields said.
Reasons for more surgery in the South included its cooler
climate, efforts by local specialists to educate GPs about
glue ear, and lower uptake of private healthcare.
Mr Fields believed publicity about the possible cost-cutting
had been a ''little bit misleading'', as the work was
However, he would be concerned if the Government introduced a
nationwide cap on the procedure.
He would not like to see New Zealand follow Britain in making
clinicians follow rigid box-ticking rules.
''Just putting a cap on the number of children we can do, as
opposed to the ones that need it, then they're in for a big
''It's bad enough that children are waiting four to six
months to have their operation in Dunedin at the moment.''
He would be happy to see more consistency in national
Grommet surgery in areas of expected high need, such as
Counties Manukau, was relatively low, which probably showed
parents there were not adequately accessing medical care, Mr
It cost $1800 to $2000 to have grommets inserted privately,
he said. In a letter to Royal Australasian College of
Surgeons chairman Scott Stevenson, National Health Committee
chairwoman Anne Kolbe said the committee would formally
engage with the New Zealand Society of Otolaryngology, Head
and Neck Surgery before making formal recommendations about
The committee's task of finding health savings was not
''Other [countries'] use of lists of ineffective or low-value
interventions, while indicating significant savings [which we
need to understand], has difficulties from our perspective.
''They are difficult to convert into the New Zealand context
and they also tend to focus on procedurally-based specialties
because of the ease of data collection,'' the letter said.
Dunedin South MP and Labour disability spokeswoman Clare
Curran said housing quality, the climate, and lower incomes
were likely reasons for the South's high grommet surgery
Cutting grommet surgery would lead to significant increases
in learning and behavioural problems, she believed.