Ophthalmology New Zealand (ONZ) is battling Southern Cross Health Insurance’s (SCHI’s) latest cost-cutting decision to no longer fund the use of anaesthetists in cataract surgery. 

According to details given to ONZ by SCHI, 23% of the highest volume cataract surgeons in the country do not use anaesthetists, so for them this is not an issue. But these surgeons may exclude patients based on the assumption they are not safe for non-anaesthetist-supported surgery and send them to the local public hospital, creating “a windfall for the private insurer,” said ONZ in an article in RANZCO’s Eye2Eye publication. “For those surgeons that consider using an anaesthetist vital for safe surgery this is a major issue.” 

This problem is compounded in New Zealand, continued the ONZ board, as SCHI doesn’t allow its members, the patients, to be charged out-of-pocket expenses, forcing the surgery to absorb all costs.

ONZ has met with the insurer several times to tackle this issue and other concerns, including the insurer’s reluctance to fund new technologies, such as the Xen Gel Stent, designed to lower high eye pressure in open-angle glaucoma, despite it being available in the public market*. It has also placed a submission with the Insurance Contracts Law Review. 

“We will continue to represent our members’ interests and may be forced to take a more public stance in future. But at this time, we are still in correspondence with the insurer and hope that a compromise can be negotiated on behalf of our patients.”

For related stories search this site for “Xen” or “ONZ”.