Over $13 Million in ED Vouchers Distributed Amid Health Concerns

More than $13 million in emergency department (ED) vouchers has been issued to patients in New Zealand between January 2021 and mid-2023, prompting concerns about access to healthcare and the potential for a “postcode lottery.” Data released by Health New Zealand to Newstalk ZB under the Official Information Act reveals that over 130,000 vouchers were distributed during this period, allowing patients to seek care at private urgent care clinics or through telehealth services.

The figures indicate that while a significant number of vouchers have been given out, the actual total may be higher, as some data remains incomplete. For instance, Southland Hospital did not track the number of vouchers issued or their costs, and Hawke’s Bay did not record voucher expenditure. A pilot programme at Auckland City Hospital began in April 2023, but financial data from this initiative is currently unavailable.

Distribution Discrepancies and Access Issues

Hospitals in Auckland led the voucher distribution, with the Waitākere, North Shore, and Middlemore hospitals collectively issuing 73,000 vouchers valued at $7.2 million. In contrast, Waikato provided 31,000 vouchers worth $4 million. Notably, several hospitals, including those in Nelson, Wairau, Christchurch, Grey, Oamaru, Lakes District, Gisborne, and Whanganui, do not participate in the voucher scheme. Furthermore, Dunedin ceased issuing vouchers in late 2022.

Dr. Kate Allan, chair of the Australasian College of Emergency Medicine New Zealand Faculty, noted that while the voucher system reflects high demand on EDs, it only addresses a small percentage of total ED presentations. She emphasized the importance of informing patients about alternatives to emergency care, as many less urgent cases face the longest wait times.

Rachel Haggerty, director of Health New Zealand’s planning funding and outcomes for hospitals, highlighted that reducing pressure on EDs remains a priority. The voucher system, established in some regions for nearly a decade, aims to reserve emergency services for those in acute need. Haggerty explained that patients assessed at ED may receive a voucher if their conditions can be managed safely at an urgent care clinic.

Concerns About Equity and System Effectiveness

The voucher system raises questions about equity and financial barriers to healthcare access. Sarah Dalton, Executive Director of the Association of Salaried Medical Specialists, expressed concerns regarding the uneven distribution of vouchers. She questioned the fairness of the system, particularly for those who visit urgent care clinics without vouchers, as well as those who pay for care only to be referred back to the ED.

Dalton recounted an instance of a patient who, after a lengthy wait at an ED, paid $120 at an urgent care clinic, only to be referred to the hospital later. She highlighted the risk that more individuals might visit emergency departments solely to obtain vouchers and avoid direct costs, potentially exacerbating existing challenges.

Peter Boot, founder of Northcare, an accident and medical centre in Auckland, criticized the voucher system as “slightly crooked,” as it limits usage to select clinics. He argued that greater efficiency could be achieved within emergency departments. Boot noted the disparity in patient expectations between hospital settings and private practices, stating that primary care should handle less complex cases.

Boot emphasized the need for increased funding for primary care to alleviate the burden on EDs. He suggested that improving primary care services would allow hospitals to focus on more severe cases, reducing unnecessary investigations and streamlining processes.

Dalton also called for an evaluation of support for facilities lacking voucher access and proposed the establishment of publicly funded, free-to-access urgent care clinics to alleviate some pressure on EDs. In response, Haggerty mentioned ongoing efforts to enhance urgent and after-hours services in underserved areas, encouraging the public to utilize resources like Healthline for guidance on appropriate care settings.

In the April to June quarter, Health New Zealand data indicated that 73.9% of patients were admitted, treated, or discharged from EDs within six hours, a slight increase from 71.2% the previous year. The government’s goal is to reach a target of 95% for timely patient care.

While the voucher system has been established to manage less urgent cases, Dr. Allan cautioned that it alone will not resolve the underlying pressures on emergency departments. She noted that the most significant challenges arise from patients presenting with complex medical issues, stating that every little effort contributes to alleviating wait times for those with minor concerns. “It’s about spreading the load across the whole health system,” she said, emphasizing the importance of ensuring patients receive timely care in the most suitable environment, which is not always an emergency department.