> Dr Adrian Midgley wrote about waiting lists
and started a fascinating thread.
Here in NZ the Govt have embarked on a more explicit process which it
remains to be seen whether it will work or not. At the moment we do not
have a commitment to a 'primary led' system so basing a scheme around GP
prioritisation would not gain wide acceptance.
The plan (as I understand it - not my area of work) is to develop explicit
scoring systems for different services and probably for each different
condition. The criteria are drawn up using the available evidence to judge
which types of people are likely to gain greatest benefit from the
procedure. They take account of social as well as medical factors. At
present they are being drawn up by individual units.
The carrot is that, when a unit has the criteria and systems in place that
will allow them to operate a booking system based on points, then the
regional purchaser of the service can apply to the Ministry of Health to
access a central pool of funds to do more operations - to clear the current
waiting list of those who have over the accepted cut off number of points
and then to be able to maintain a steady state of waiting time to operation
for those who reach the cut-off point.
The concept also includes publication of the criteria and scoring system so
that referrers know whether an individual will qualify for operation and
therefor whether it is worth referring at all at this time.
Naturally there are problems with this idea. I guess there will be 'point
creep' around the margins as referring doctors and individual patients
become good at realising what needs to be emphasised to improve ones
chances of success - that seems to be what happens in the housing
allocation system. I worry about the perverse incentives that might apply
- if you really want your cataract op you'ld better start having a few
accidents. Also there will be some conditions where it is easier to
develop criteria than others.
Arguably though the objective criteria approach is fair - it's certainly
going to make it a bit harder to jump the queue. And mentioning that, how
do fundholders - those of the two tier system - like your idea?
What do people think of the NZ idea - has it been tried anywhere already?
Dr John Marwick, NZ Ministry of Health, PO Box 5013, Wellington, NZ
Home: 12 Konini St, Eastbourne, Lower Hutt, NZ
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