The report, provided to the Otago Daily Times anonymously, says progress towards achieving fairness in the allocation of first specialist appointments (FSA) has been slow.
"We are not confident that the patients with the highest needs, relative to others, are consistently obtaining access to scheduled services."
The report, under the name of controller and Auditor-general Lyn Provost, says there is no good quality information that would let anyone reliably comment on how much progress, if any, has been made towards achieving national equity of access.
It is critical about consistency, saying that even when nationwide or local priority methods are used, boards "do not use the resulting scores to ensure that patients are treated in priority order".
The office said it "found no relationship between a patient's priority score and the time they waited for treatment".
Health Minister Tony Ryall, asked whether he was confident that the right people were getting surgery, gave an email response focusing instead on the gains made in the amount of elective surgery being carried out.
He said he had not read the draft report.
The Ministry of Health had advised him it was being checked and there "is information in the draft that is imprecise or incorrect".
The Government's focus had been on increasing the amount of elective surgery and a record 400 extra people received an operation every week.
In the Southern District Health Board area almost 3000 extra patients had elective surgery in the previous financial year compared with when Labour was in power, he said.
The report assesses the progress in achieving the objectives of the "reduced waiting times for public hospital elective service strategy".
It is critical about the availability of some information, saying it wanted to know about waiting times for patients, but this data was not publicly available.
The strategy intends each patient offered a first specialist appointment waited no longer than six months, but boards were consistently falling short of this.
"Their performance has not improved since September 2006, which indicates that incentives to make further improvements are weak or absent."
As well as the strategy standard, the ministry required boards to ensure 90% of patients received their FSA within two months.
"The ministry could not tell us whether this has been achieved because it does not collect the relevant data."
The report said it considered it was unlikely this standard was met.
Timely access to diagnostic tests had received "sporadic attention" in the past 10 years, something which undermined faster treatment. Access criteria needed to be consistent, the report said.
The Auditor-general's office will publicly report on the progress towards meeting the strategy's objectives in 2013, but says it expects the ministry and boards to have agreed before then on how to improve progress.
