Otago District Health Board may be penalised for doing elective surgery for other boards but doing less than planned for its own patients, hospital advisory committee chairman Richard Thomson says.
At the recent committee meeting, it was pointed out that by the end of January the board had completed about a third more elective surgery for other boards than planned, but was behind targets set for its own population.
Mr Thomson said this situation meant the board could be enabling other boards to meet their elective targets while Otago could not meet its own.
When the board does elective surgery for out-of-district patients, other boards pay Otago for the work done but the surgery is counted in the other boards' surgery volumes.
The levels of elective surgery to be done for other boards are set out in the board's contract with the ministry.
Under the plan, surgeons are required to operate on those patients considered most in need of surgery, which means in some instances out-of-town patients will get priority.
Mr Thomson said the situation could mean Otago patients were effectively penalised twice.
"Somebody else hops up and takes their place in the queue and then they are penalised again, by the board being denied funding if Otago does not meet its totals."
Boards are required to undertake surgery within specified times for their own patients and if they fail to meet these times for three consecutive months they can be penalised by receiving funding in arrears rather than in advance.
At the end of a year, if surgery volumes are not met, they also may not receive extra elective surgery funding which they may have already factored into their budget.
Chief operating officer Vivian Blake said the move to one board would be a "huge opportunity" to minimise the risk of not meeting the targets.
She agreed it could mean that Dunedin patients would be given the option of travelling to Invercargill for some procedures.
Mr Thomson is critical of the Ministry of Health system, which based the amount of out-of-district surgery the board had to complete on two-year-old data.
Mrs Blake said two years ago Otago had a complicated out-of-district cardiac surgery case which attracted a high number of caseweights. (Caseweights are used to measure how much money, staffing and time in hospital each operation needs.
The more complicated the surgery is , the more caseweights are allocated.)Because this was included in surgery calculations for this year, the caseweights the board had to complete were higher than might have otherwise been expected.
As well as meeting caseweight targets, the board has to treat a certain number of patients and the Government has required all boards to undertake extra elective surgery this year.
Mrs Blake said there was a gap between the number of case-weights the board considered it could meet and the volumes required, which meant the board was seeking outside support from other boards such as Southland and South Canterbury and private hospitals in Invercargill and Dunedin.
Mr Thomson would like to see a system based on the total throughput of the hospital.
This would include elective and acute surgery and would be a true measure of a hospital's effectiveness and efficiency.
"We shouldn't be penalised for not doing a certain number, as long as we still meet the overall target."
In an email response to questions from the Otago Daily Times, National Health Board business unit national director Chai Chuah said the high out-of-district case-weights example highlighted that using a measure such as case-weights alone might not provide the comprehensive picture of surgery performance.
The national board would be working with district health boards on how to improve the measurement of effectiveness, efficiency and productivity of surgery in the coming year.
This work would need to take into account the targeted health outcomes, what surgery would be required to meet them and the resources needed.
Surgery statistics for the past financial year show the board treated 10,671 surgical patients, 54 more than the previous year, and the complexity of the surgery had also increased by 1072 caseweights.
This year, the board is expected to complete about 500 extra operations.
