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A study has revealed the fate of the "invisible'' patients who need hip or knee replacements but are turned away because of financial constraints at Dunedin Hospital.
The senior author of the study published in the New Zealand Medical Journal late last week was Associate Prof David Gwynne-Jones, with co-authors registrar Ayaaz Ebramjee, medical student Toni Anitelea and statistician Dr Ella Iosua.
It looked at 374 patients sent back to GPs because they did not meet the "financial threshold''.
It was despite their surgeon saying they needed the operation.
Only 6% opted to go private after being turned away.
"Those who can afford to self-fund tend to bypass the public system altogether,'' the study said.
Nearly 62% (230 patients) were re-referred, of whom 194 received surgery and 36 were turned away again.
A third received no further referral to hospital within the study period.
The average waiting time for those initially turned away who ended up getting the surgery was nearly 15 months after their first specialist assessment.
Referring patients back to GPs kept them off the books, allowing the health board to meet a national four-month surgical target.
"While those accepted on to the wait-list will get their surgery [within four months], it does not increase the numbers of procedures done.
"Because failure to meet the target may be associated with financial penalties to the DHB, the unintended consequence is that more patients are being returned to GP purely to meet the target.
"They do not show up on waiting lists, so are invisible,'' the study said.
Up to 41% of all joint replacement patients were being returned to GPs for financial reasons.
"This delay results in waste, added costs to the patient, healthcare system and society and may reduce the benefit of surgery.''
The patients had been returned to GP between November 2013 and December 2015.
When contacted, Prof Gwynne-Jones, a Dunedin Hospital orthopaedic surgeon, said the study built on his previous research into care rationing in the South, but the "scale of it'' continued to strike him.
"It's all very well for the Government or ministry to
say 'return to GP' ... but nobody's actually then followed up to see what's happened to those people,'' he said.
For patients, "going round in a cycle'' was a "waste of time''.
Prof Gwynne-Jones said he was a "little bit surprised'' the private surgery rate was not higher in the cohort.
"It's a big-ticket item. And the demographic round here is that lots of people can't afford it.''
He was "waiting with interest'' to see what new Health Minister David Clark would do about the situation.