Patient travel cost inertia

Another example of how far we are from removing the post code lottery for healthcare was highlighted this week.

It is not the first time the Cancer Society has drawn attention to the inadequacy of assistance to patients who must travel beyond their communities for treatment.

In this instance, it involved Otago and Southland cancer patients who have to travel to Christchurch because of the shortage of radiation oncologists in Dunedin.

It was concerning to hear for some families the cost of this was having an impact on the decisions they made about their treatment.

In a country as small as ours, it would be unreasonable to expect complex medical treatments to be provided within cooee of where everybody lives.

But, if the fairer access for all promised under the health reforms announced two years ago is to be achieved, there must be adequate financial support provided to those who must travel significant distances to receive cancer and other treatments.

This is where the National Travel Assistance (NTA) scheme comes in. Introduced in 2005, it was designed to provide some financial assistance towards travel and accommodation costs to those with the greatest need. It replaced existing policies with the purpose of improving national consistency.

It was aimed at those who had to travel long distances to access specialist services, those who had high travel costs because of frequent visits to specialist services and those who had significant financial needs that might otherwise prevent them from accessing necessary specialist services.

Its aspirations were laudable, but for years there were concerns it was not improving equity of access to health services. The process for claiming was too complicated, the scheme was inconsistently applied and some deserving people on the margin of eligibility for funding often missed out.

Those in the former Southern District Health Board area have always been big users of the scheme due to the size of the region and its rurality. A review of the scheme, completed in 2018 and published in 2019, showed there was already concern some people were foregoing treatment because of cost. The Ministry of Health said then the scheme needed to be more patient-focused, provide practical solutions, be streamlined, flexible enough to allow discretion for local circumstances and be more consistent between regions.

It seems nothing has changed despite the lofty aims of the review: to ensure the scheme was fair and equitable, those with the highest needs were accessing it, that the administration of the scheme worked for people and payment levels represented a reasonable contribution to people’s actual costs.

It is dismaying that, at the very least, that last objective has not been addressed. Even though the scheme was not designed to cover full costs, why has the 28c a kilometre for private vehicle travel remained at that level since at least 2010? The current Inland Revenue Department rate for the first 14,000km is 95c per km. Similarly, the contribution of up to $100 a night towards accommodation is out of step with current costs.

Last November, HNZ said it was aware of the urgent need to review the NTA. It repeated that this week, saying that transition from a system based on 20 district health boards with variations in access to care would take time.

We agree HNZ needs to get this right, and we appreciate the Covid-19 pandemic will have had an impact on action following the 2018 review, but it is not clear how much more time will be taken on this work.

Being aware of the urgency of something and addressing it urgently are different, and HNZ needs to get on with the latter.

Cash-strapped and stressed patients, and their families, deserve a break.