Media release from Otago District Health Board

Otago and Southland District Health Boards' (DHBs) proposal  "Bridging the Gap"  is about patients currently receiving treatment in the public health system who would like to access treatments that are not publicly funded - it is not about user pays -  says Otago DHB Consultant Medical Oncologist Dr Christopher Jackson.

"Our proposal is about patients accessing effective treatments that are not government funded, and are delivered as close to home as possible, and in the public setting, says Dr Jackson.

" It is not, and never has been, about user-pays, since all government funded treatments will still be provided free; no patients will ever be able to buy their way up the public waiting list - for that to happen, patients can continue to use the private hospitals elsewhere."

The proposal "Bridging the Gap" originated from the Southern Blood and Cancer Service as a mechanism for helping patients access unfunded cancer treatments.

"Specifically, we are interested in access to cancer treatments," says Dr Jackson.

"We know that cancer remains the leading cause of death in New Zealand, accounting for 29.4 percent of all deaths[1][1], and that when compared to other OECD countries.  These conditions have led to many patients seeking access to new medicines outside of the Pharmac mechanism and has repoliticised the debate surrounding funding of cancer medicines[2][2]".

"There is always a lead time between evidence for a new treatment being available and the government funding it.  For some patients that wait is too long."

"Many of our patients have to travel to other centres to receive "top-up" chemotherapy treatments, says Dr Jackson. "One of our patients has had to travel on a Monday from their provincial town to Palmerston North for chemotherapy treatment on a Tuesday. As well as paying for the treatment, he has also paid for his flights, accommodation and loss of earnings by being away from work. We could have given him the same treatment in Dunedin, but we were not allowed to."

"Another person, the husband of a patient, reported that his wife had a rare form of cancer which does not respond to any of the currently publicly funded cancer drug," says Dr Jackson.

"They had to completely exit the public system on a number of occasions in order to be treated with an unfunded drug.

"This means that her care was disjointed between the public and private sector - that is not good medicine and certainly not good for our patients.

"It's not just the cost of the unfunded drug that can be an issue," says Dr Jackson. "Patients and their families have also expressed concern relating to the stress and costs involved in finding a private doctor to take them on which may include travel to other centres as well as the process of bringing them up to speed on their condition and proposed treatment."

"Then you need to pay for the drug (often with a sizeable mark-up by the time it passes through the pharmacy), the drug administration costs, and potentially for other drugs to combat potential side-effects.

"The total of all these costs already puts some treatments beyond the reach of most people, and the added stress of dealing with another new medical team can be enormous."

Vivian Blake, Chief Operating Officer, Dunedin Hospital, says "the consultation asks the question in a general sense because there may be other treatments or conditions where top-up drugs and services are available, and we did not want to have two sets of rules within the hospital."

"Our focus is specifically on cancer drugs which are currently unfunded.  The proposal for the pilot has always been about cancer drugs, but we cannot have two sets of rules operating in the hospital for two sets of patients."

She continues "If our population and staff support this proposal, and the Minister agrees, we propose to pilot this around cancer treatments so that, where clinically applicable, patients can choose to pay for top-up treatments in addition to the treatment already being received under the public health service.  At the end of the pilot, we will need to consider the broader implications for the hospital and the health care sector."

"We see this as benefiting the patients, and their families, in a number of ways, as it opens up the possibility of top-up treatments otherwise unavailable in the public health system, and does so as a whole package of care."

The consultation closes on 2 February 2010. An online survey can be accessed through the Otago and Southland DHBs' websites, or by contacting Chris Crane on 03 4709188 or by email (chris.crane@otagodhb.govt.nz).