title: Explicit rationing of elective services: implementing the New Zealand reforms.
abstract: In an attempt to make rationing of elective surgery in the publicly funded health system more explicit, New Zealand has developed a booking system for surgery using clinical priority assessment criteria (CPAC). This paper is based on research undertaken to evaluate the use of CPAC. To explore whether the goals of explicit rationing were being met 69 interviews were undertaken with policy advisors, administrators and clinicians in six localities throughout New Zealand. The aims of reforming policy for access to elective surgery included improving equity, providing clarity for patients, and achieving a paradigm shift by relating likely benefit from surgery to the available resources. The research suggests that there have been changes in the way in which patients access elective surgery and that in many ways rationing has become more explicit. However, there is also some resistance to the use of CPAC, in part due to confusion over whether the tools are decision-aids or protocols, what role the tools play in achieving equity and differences between financial thresholds for access to surgery and clinical thresholds for benefit from surgery. For many surgical specialties implicit rationing will continue to play a major part in determining access to surgery unless validated and reliable CPAC tools can be developed.
authors.affiliation: Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington South, New Zealand. kdew@wnmeds.ac.nz
authors.forename: Kevin
authors.initials: K
authors.lastname: Dew
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cumming
authors.forename: Deborah
authors.initials: D
authors.lastname: McLeod
authors.forename: Sonya
authors.initials: S
authors.lastname: Morgan
authors.forename: Eileen
authors.initials: E
authors.lastname: McKinlay
authors.forename: Anthony
authors.initials: A
authors.lastname: Dowell
authors.forename: Tom
authors.initials: T
authors.lastname: Love
mesh_terms: D017558:Elective Surgical Procedures; D015276:Health Care Rationing / Q000458:organization & administration*; D018166:Health Care Reform; D006801:Humans; D009313:National Health Programs; D009520:New Zealand; D014850:Waiting Lists