Dr Stephen Child

The following is a response from the Southern Cross Health Society to an edited version of an article first penned by Ophthalmology New Zealand (ONZ) about its concerns regarding funding for anaesthetists in cataract surgery, from Dr Stephen Child and Rebecca Ogilvie.

We are writing in response to the article titled, Anaesthetists for cataract surgery? published in the July 2019 issue of NZ Optics.

Following our letter to you on 3 April 2019, we were concerned to read a second article containing misleading information about Southern Cross Health Society’s (SCHS) position, this time about the use of anaesthetists in cataract surgery. 

This latest article contains information attributed to the Ophthalmology New Zealand (ONZ) Board which is simply not correct. SCHS does not dictate whether an anaesthetist can be used in cataract surgery. We negotiate and agree one rolled-up price for cataract surgery, which has been the case with most of our ophthalmology contracts since 2011. It is up to the individual surgeon to decide whether to use an anaesthetist in consultation with the patient, and for the practice to apportion appropriate payments to those involved in the surgery.  

The article also states that SCHS does not allow members to be charged out-of-pocket expenses. As stated in our letter to the editor published in May’s issue, we fundamentally disagree with the concept of “gap” payments in which a member is asked to “top up” a contribution for their treatment (other than for agreed excesses, shared cover contributions and policy exclusions). We did trial a gap payment for a selected procedure and the affected members were very clear with us that this wasn’t what they wanted. We have previously shared this information with the members of ONZ. We know in Australia, where for-profit insurers and providers have long embraced this concept, patients have become worse off, to the extent that the government formed a ministerial advisory group to provide recommendations on “out-of-pocket” costs. You can find the report here: https://bit.ly/2YCoRjL

As a not-for-profit Friendly Society, SCHS is responsible for funding healthcare for our 870,000 members. The number one issue they raise with us is the affordability of their premiums. To ensure the long-term sustainability of the private healthcare sector, we have moved to become an active purchaser of services to procure the best value care for our members. In the past 12 months alone, we have paid out about $74m in claims for ophthalmology services.  

In summary, we are concerned that ONZ continues to use NZ Optics as a vehicle to provide incorrect information. On many occasions, we have been clear with ONZ that whether an anaesthetist is used in cataract surgery is the decision of the clinician.

Thank you for the opportunity to provide a balancing perspective, albeit after the fact. 

Yours sincerely 

Stephen Child, chief medical officer, SCHS and Rebecca Ogilvie, chief of healthcare partnerships, SCHS