14 July 2022
Emma Vitz
Ī
mēra / Email: [FYI request #19607 email];
Kia ora / Dear Emma
Official Information Act request WCD (West Coast District) 9709
I refer to your email dated 7 June 2022 to Ministry of Health which they subsequently transferred to us on
15th June 2022 requesting the following information under the Official Information Act from Te Tai o Poutini
West Coast regarding outsourcing elective surgeries. Specifically:
1. The total number of procedures outsourced by year (including the year to date) for the past five
years.
2. For each year, provide a breakdown of the type of procedure.
3. For each year, provide the total spend on outsourced elective surgeries.
4. For each year, provide the amount that these surgeries would have cost the DHBs if they had not
been outsourced.
Te Tai o Poutini West Coast outsources planned care ophthalmology services, as there is no local service
within our district. This includes outpatient as well as inpatient services. In answer to Questions 1 and 2, the
total numbers, types of elective ophthalmology surgical procedures surgery, and relative values of these
surgeries undertaken (using national Inter-District Flow (IDF) reference prices at the relative case weighted
value per procedure as the cost derivative) over the past five years from 1 July 2017 to 31 May 2022 is listed
in
Appendix 1 – Table one (attached):
In respect of Questions 3 and 4 – we note that prices paid by West Coast for outsourced ophthalmology
surgery are not directly comparable to prices that would be paid for patients referred to other DHBs for
surgery, and which would be paid at national inter-district flow (IDF) reference prices. These have varied
each year; so that at times, surgery prices paid for out-sourced services are higher, and at other times similar
or lower than IDF prices.
Prices paid for cataracts and associated pre- and post-surgical follow ups have been at fixed price, which have
modified from year to year. Prices for non-cataract procedures over the past five years were individually
priced - based on complexity and input required to treat each individual case. These prices were generally
at or around the price paid had the DHB referred them to another DHB for care; with a number also being
slightly lower than national reference prices. Not all prices were accepted.
Those referrals that were priced at rates notably above national reference prices were passed to other DHB
services for the surgery to be undertaken for cases where clinical considerations and/or relative urgency
were not otherwise an over-riding influencing factor in having procedures promptly undertaken through the
private sector. Equally, higher prices were sometimes accepted at the time in order to secure prompt access
to treatment for the patients concerned due to their individual circumstances.
Given these variabilities and number of surgical procedures involved - particularly for non-cataract
procedures - we are declining to retrospectively review and reconstruct comparative prices all of the
outsourced cases to IDF prices over the past five years in answer to Questions 3 and 4 under Section 18 (f) of
the Official Information Act i.e.
“… that the information requested cannot be made available without
substantial collation or research.”
Other Outsourced Services
Other than ophthalmology, West Coast DHB has more recently contracted for up to 35 orthopaedic major
joint (hip and knee replacement) procedures and up to 20 plastic surgery procedures to private providers in
the period May and June 2022. These procedures were still being undertaken at the time of your Official
Information Act request being lodged. These are contracted out at higher prices than we would otherwise
have paid another DHB to have undertaken the procedures and follow-up care.
I trust that this satisfies your interest in this matter.
You may, under section 28(3) of the Official Information Act, seek a review of our decision to withhold
information by the Ombudsman. Information about how to make a complaint is available at
www.ombudsman.parliament.nz; or Freephone 0800 802 602.
Please note that this response, or an edited version of this response, may be published on the Te Tai o
Poutini West Coast website after your receipt of this response.
Ngā mihi / Yours sincerely,
Ralph La Salle
Senior Manager, OIAs
Waitaha Canterbury / Te Tai o Poutini West Coast.
TeWhatuOra.govt.nz
PO Box 1600, Christchurch,
Postcode 8011
9709 Appendix 1 – Table 1
Net Value at
Total
National Inter-
Financial
Surgery
Type or Procedures
District Flow
Year
Procedures
(IDF) Reference
Prices
• Cataract surgery – 233
RELEASED
• Glaucoma and complex cataracts – 23
• Corneal, scleral and conjunctiva procedures - 9
2017/18
288
•
$715,971
Strabismus procedures – 7
• Eyelid procedures – 6
• Other ophthalmic procedures * - 10
• Cataract surgery – 230
UNDER
• Glaucoma and complex cataracts – 23
2018/19
275
• Eyelid procedure - 6
$636,098
• Corneal, scleral and conjunctiva procedures – 5
• Other ophthalmic procedures * - 11
• Cataract surgery – 185
THE
• Glaucoma and complex cataracts – 6
2019/20
200
$512,739
• Corneal, scleral and conjunctiva procedures – 3
OFFICIAL
• Other ophthalmic procedures * - 6
• Cataract surgery – 220
• Eyelid procedures - 17
• Glaucoma and complex cataracts – 13
2020/21
270
$748,099
• Corneal, scleral and conjunctiva procedures - 5
• Strabismus procedures – 4
INFORMATION
• Other ophthalmic procedures * - 11
• Cataract surgery – 149
2021/22
• Eyelid procedures - 12
to 31 May
187**
• Glaucoma and complex cataracts – 9
$612,805**
2022**
• Corneal, scleral and conjunctiva procedures - 7
• Other ophthalmic procedures * - 10
Notes:
ACT
* Other ophthalmic procedures – includes a range of enucleations, orbital procedures, retinal
procedures, dacryocystorhinostomy, lacrimal procedures, lesion removal and skin grafting
repair procedures on eyelids, and other such operations on and around the eye.
** Data for eleven months to 31 May 2022 only.
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