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Public hospital system referral

Being seen in the private sector does not give you priority of access to outpatient clinic assessment or surgical waiting lists in the public hospital system.  Here’s how it works...

Public Hospital System Referral

If your problem is not covered by ACC and you do not have health insurance or other means of paying for treatment privately, you can ask to be referred to the public hospital system; but there are some important things you need to be aware of. Some patients are initially seen privately under ACC funding but cover is later discontinued or requests for surgery to be performed at ACC’s expense are declined by ACC.  Although such a decision by ACC can be challenged, I will give you a good indication of whether such a challenge is worth pursuing.  More information about ACC can be found here. Some patients are initially seen in the private sector under ACC but other findings needing further evaluation or treatment are picked up on scans and other tests which are not related to the ACC covered injury. Some patients initially pay to see a specialist privately but do not have the financial resources to continue to pay for further tests or investigations, or treatment.  Paying to see a specialist privately will NOT make it easier to get into the public hospital system.

Your options include:

Pay for private consultations and surgery using your personal financial resources. Use health insurance if you have it.  Depending on the policy and the level of cover you have, you may have to make a contribution towards the cost of your consultations or surgery.  In this day and age, I strongly recommend health insurance to all my patients. Just because ACC accepts the initial registration of an accident or injury that has occurred, this DOES NOT mean that all investigations and treatments that follow (including surgery) are automatically covered by ACC.  ACC will likely pay for your consultations and surgery if a genuine injury has occurred and ACC have accepted cover for it.  ACC constantly reviews the information they have available to them from multiple treatment providers as the diagnosis and treatment of your condition proceeds.  More information here. You may choose to be referred to the public system. The public hospital system is not perfect but still delivers very good healthcare for urgent conditions and emergencies.  Unfortunately not all people with health problems that would benefit from diagnosis and treatment in the public health system are able to be seen due to resource limitations.  If accepted, it can take many months to get an outpatient clinic appointment.  Access to complex investigations and scans may also take many months.  On the other hand, genuinely urgent problems are usually dealt with efficiently and promptly.

If your care needs to be transferred:

1. If you need more investigations or scans done in the public hospital system, I will refer you to the public hospital.  The referral, complete with relevant supporting documentation, will be assessed and prioritised by public hospital doctors before an appointment is sent out to you.  There is no guarantee that your condition will meet the threshold (set by the hospital) for being given an appointment but I will try to give you an idea as to the likelihood of the referral being accepted. 2. There is no guarantee that you will be seen or treated by a particular surgeon but, if your referral is accepted by the hospital, you will be assessed by a qualified speciality team with expertise. 3. If you receive an appointment, it may be changed a number of times before you are finally seen because clinics are heavily booked and patients are being re-prioritised all the time as patients are added and removed from clinics as dictated by the urgencies of their conditions.  4. The public hospital system does its best to ensure you won’t suffer any harm by waiting but it is VERY IMPORTANT THAT YOU KEEP IN CONTACT WITH YOUR FAMILY DOCTOR (G.P.) REGARDING YOUR CONDITION AND THAT YOU REPORT ANY WORSENING OR NEW SYMPTOMS TO YOUR G.P. 5. If you are referred to Wellington Regional Hospital (Capital and Coast DHB), you need to be aware of the following statement, previously issued by the DHB: “The District Health Board has to give priority to patients with the greatest level of need and is not able to provide assessment and surgery to all patients who would benefit from it.  Your level of need and the potential benefit you could get from surgery will be considered against other patients.  You and your GP will be advised in writing as to whether or not you meet the threshold for assessment or surgical treatment. Having been initially seen in the private sector does not give you priority in the public hospital system.  Priority is based on the clinical urgency of your problem.  I do not have right of access to clinic assessments or to surgical waiting lists on behalf of private patients.  If you live in an area not covered by the Capital and Coast DHB and require referral to the public hospital system, I am required to refer you to your GP or referrer who can refer you to the local hospital which is run by your DHB.
Mark J Sherwood, Orthopaedic and Spinal Surgeon Island Bay, Wellington, New Zealand
Pacific Orthopaedics