A leading surgeon doubts the Government will be able to save
money by cutting down on treating children's ears with
Scott Stevenson, an ear, nose and throat surgeon, was
commenting on a government group's suggestion New Zealand
could save $4.4 million a year if its rate of grommet
insertion was lowered to Britain's level.
"The savings probably aren't there," said Mr Stevenson, the
chairman of the New Zealand board of the Royal Australasian
College of Surgeons.
The National Health Committee, which is responsible to Health
Minister Tony Ryall, is trying to find $30 million of savings
in the public health system for reinvestment in more
effective or better-targeted treatments.
It has looked at a British list of 550 "relatively low
priority" elective surgical procedures and said New Zealand
spent $641 million a year on the "top 25" of those. It will
not name the 25 procedures, but has analysed the use of
Grommets are tiny tubes placed in an incision in the eardrum.
They are used to treat recurrent acute middle-ear infections
and ongoing glue ear. The two conditions usually coexist and
both involve fluid behind the eardrum.
Acute middle-ear infections can cause severe pain, fever,
grumpiness and interrupted sleep. Glue ear may have few
symptoms, although ear pain may occur and hearing loss is
common, sometimes enough to delay speech and language
development. Glue ear can impair balance, too.
Grommet insertion, which carries some risks, would not
normally be considered unless a child had had four acute
episodes in six months, or six in a year - or until after
three to six months' monitoring of glue ear and evidence of
Mr Stevenson said the college had concerns about the ideas
the National Health Committee expressed on grommets in a
discussion document and he had responded "fairly vigorously".
The ideal intervention rate for grommets was unknown.
"No one has looked at that and said are we over-treating or
is the UK under-treating.
"Maori and Pacific people have a high incidence of middle-ear
disease. I would hate to see anything done that impacts on
our ability to look after some of our most economically
deprived and underprivileged kids."
Auckland ear, nose and throat surgeon Dr Colin Brown said,
"The UK is not a good reference point in terms of whether we
do more or less. In my opinion children are substantially
under-treated in the UK."
He said that in the past 10 years, New Zealand specialists
had become "much more conservative" about inserting grommets.
Mr Stevenson said the college was collaborating to write
national guidelines for treating ear infections and later a
survey of intervention rates would be done.
Labour's health spokeswoman, Maryan Street, said reducing the
number of grommet operations for children - without a direct
investment in measures to reduce the need for the treatment -
would be a false economy that led to "more kids sitting in
class unable to listen and learn".
- Martin Johnston of the New Zealand Herald