In the report, "Providing equitable access to planned care treatment", tabled in Parliament last week, John Ryan says the Pae Ora (Healthy Futures) Act requires Health New Zealand Te Whatu Ora to ensure Māori and other population health groups have equitable access to the health services they need.
This means ensuring access to elective or planned treatment is based on clinical need, not background, circumstances or where they live.
He concluded the way treatment is provided is often not equitable or timely.
It depends on where you live. Those waiting longer are disproportionately those living in rural areas, those socially deprived, Māori, Pacific peoples, and those with disabilities.
Thresholds to qualify for treatment are not consistent across the country, a throwback from the old district health board days, and although there is work under way to introduce national thresholds, this is not going to happen overnight.
A national threshold has been introduced for cataract treatment. This meant about 1800 people were added to the waiting list in the Southern district.
The report shows the huge variance in the orthopaedic thresholds. In Southern, for instance, your condition would need to be significantly worse to qualify for treatment than if you were in Canterbury or Auckland.
The Auditor-general is far from the first to raise concerns the government’s emphasis on using the private sector to provide more timely treatment could result in less equitable access to treatment.
For a start, private hospitals providing outsourced treatment are not equally distributed across the country.
(Health Minister Simeon Brown has downplayed this issue, citing the availability of the National Travel Assistance Scheme to help those who have to travel away from home for treatment. However, despite some improvement to the rates last year, this still leaves anybody travelling a long distance by car for treatment considerably out of pocket.)
Patients with comorbidities making them unsuitable for treatment at the private hospitals were more likely to be Māori and Pasifika or socially deprived.
Another issue raised in the report was the lack of translation services in some private clinics, so they might not accept patients with no or limited English language.
Complex patients not suitable for private hospital treatment would remain on a waiting list in a public hospital while others with similar clinical needs would be treated privately.
"This can complicate efforts to ensure that long-waiting routine patients are prioritised and, ultimately, that Health New Zealand provides treatment equitably for all New Zealanders."
Making changes in one part of the stretched health system can often affect another part, something not always fully appreciated by policy makers.
The report points out, for instance, when clinicians spend more time providing planned care, they have less time to provide first specialist assessments.
Another concern of the Auditor-general is the lack of information about unmet need, and although he acknowledged this could be difficult, HNZ would benefit from a better understanding of it.
"A good place to start would be to measure the level of unmet need from people who are referred for assessment but do not meet current treatment thresholds," he wrote.
There have been calls for better understanding of unmet need for years, but little enthusiasm from politicians to assess this in a comprehensive way, possibly because they are fearful of what it would expose.
Mr Ryan’s planned care recommendations for HNZ include making a plan with clear times for introducing nationally consistent thresholds, acting to improve equity of access and ensuring faster access did not increase inequity, strengthening knowledge of unmet need, and clear public reporting on how long people wait for treatment, variations in access and how it will improve equity of access.
The issues raised in the report should be taken seriously by HNZ and its political masters, but the government’s almost simplistic focus on its narrow set of health targets does not convince us they will be.
