Radiology shemozzle

The drama around the provision of radiology services in New Zealand highlights the tension between public and private healthcare.

Those involved in ramping up private provision of scanners want us to believe they are all about improving patient access but there will be some scepticism about whether making money is the driving force.

Not that it is unusual for private medicine to be a money-maker.

What is not so clear in the case of radiology is whether we are getting, or will get, the best bang for our buck.

Already figures in an Accident Compensation Corporation review of high-tech imaging (HTI) showed it was paying 40% more than it would in Australia.

ACC has experienced a multimillion budget blow-out in this area.

Also, in a 2017 graph showing the cost of a magnetic resonance imaging (MRI) scan in seven countries, New Zealand’s price was $750, second only to the United States at $1430, and still well ahead of South Africa ($500), the United Kingdom and United Arab Emirates ($450), Switzerland ($310) and the Netherlands ($190).

ACC has frozen its rates to private providers this year, but there has been some concern about the validity of that decision given the gaps in the radiology data.

In common with many aspects of our health system, radiology provision is complicated with public provision suffering from underfunding and short staffing.

The mess of the information technology involving some North Island centres revealed this week by RNZ illustrates that.

An outspoken critic of the public provision is retired oncologist Dr Lyndell Kelly who fought for better services as a member of the last Southern District Health Board. She told an RNZ series on radiology services issues, funding private scans had helped patients but at the cost of draining much from hospital budgets.

Contract negotiations were ‘‘pretty one-sided’’ when the public services were so poor, with negotiators backed into a corner and ‘‘forking out this money in a panic-stricken way’’.

Her comments come as a private firm moves to offer PET scanning in Dunedin, a service which southern patients need to travel to receive.

PET scans were planned to be offered at the new Dunedin Hospital but are one of the services reported to be under reconsideration; should it be cut, that would further ratchet up the amount spent funding private scans.

The question is whether the more than a billion dollars being poured into private provision of services could create more competition and bring the price down for the public purse, particularly if the public health system were able to negotiate more long-term contracts with the private sector.

But that could pose problems if it were to result in a further downgrading of the public system which is, after all, where most training and research occurs, and which picks up more difficult cases.

Something which will have to be settled is the legal stoush between existing providers and some newer players which are bringing in surgeons as shareholders.

The concern is about the possibility for financial incentives forming part of surgeons’ decision-making for their patients.

The Orthopaedic Association has hit back at any suggestion of impropriety, describing it as ‘‘big money trying to disrupt and scare off potential players in the radiology market to protect the financial interests of those who stand to maintain very big pay-outs for their shareholdings’’.

Quite where the new Te Whatu Ora Health NZ stands on any of this is unknown. Although its priorities for the next two years are expected soon in the interim New Zealand Health Plan, RNZ reporting suggests we should not expect much clarity about radiology.

It is, however, supposedly one of the services for which a single national approach is planned.


And another thing

It is hard for southern communities not to feel in limbo in the health system’s grand scheme as we wait to find out where the 10 or so localities for the old Southern DHB area will be, although the first is expected to be announced soon.

These are the bodies which are to provide advice to Health NZ about the specific health needs in their community.

When they are eventually up and running, we hope they will be much more open than Health NZ has been to date.