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Public hospital system referral
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