This is a topic that came up over the break that I noted to write about when I got back to posting. The Nats want to cut the budget for surgery to install grommets, a technique for treating persistent ear infection (especially in children). The rationale is summarised in this Herald piece:
Govt eyes cuts to elective surgery
The National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit. The money would be used for smarter investment in other parts of the health system.
The only specific elective procedure the committee has so far named for “disinvestment” is the insertion of grommets. Grommets are tiny ventilation tubes placed in an incision in the eardrum to treat persistent, painful infections called glue ear.
[The committee] … draws on a Welsh health system report that evaluated 550 elective procedures deemed to be of “relatively low priority”. … The Welsh report’s specific procedures are listed under 17 surgical and dental headings, including tonsillectomy, grommets, varicose veins, haemorrhoids, dilatation and curettage, hysterectomy, gallbladder removal, caesarean section, lower-back procedures, circumcision, eye-lid surgery, nose surgery and surgery to correct protruding ears.
OK, so, there are 17 “headings” to explore, including purely cosmetic options like the correction of protruding ears, and so far the only one specifically mentioned and targeted is grommets. That’s a procedure which in many cases helps restore the sense of hearing, and is used mainly by (you guessed it) children in poor families. Brilliant.
The committee said it had completed a technological note on the use of ventilation tube grommets for treating middle-ear infections (otitis media). “The evidence indicates that the use of ventilation tubes is of limited value in treating otitis media with effusion, although it does not suggest that it should be stopped completely.”
New Zealand’s rate of grommets use is about 75 per cent greater per capita than Britain’s. “The difference represents a cost to New Zealand of approximately $4.4 million per annum,” the committee says.
Save $4.4 Million a year by bringing ourselves in to line with Britain. Did anyone on “The Committee” stop to ask if it was Britain or NZ that had it right? Of course not. But Kiwi doctors have let us know what they think:
Doubt over savings from restricting ear treatment
A leading surgeon doubts the Government will be able to save money by cutting down on treating children’s ears with grommets.
Scott Stevenson, an ear, nose and throat surgeon, was commenting on a government group’s suggestion New Zealand could save $4.4 million a year if its rate of grommet insertion was lowered to Britain’s level.
“The savings probably aren’t there,” said Mr Stevenson, the chairman of the New Zealand board of the Royal Australasian College of Surgeons. … Mr Stevenson said the college had concerns about the ideas the National Health Committee expressed on grommets in a discussion document and he had responded “fairly vigorously”.
The ideal intervention rate for grommets was unknown. “No one has looked at that and said are we over-treating or is the UK under-treating.
“Maori and Pacific people have a high incidence of middle-ear disease. I would hate to see anything done that impacts on our ability to look after some of our most economically deprived and underprivileged kids.” [my bold]
Auckland ear, nose and throat surgeon Dr Colin Brown said, “The UK is not a good reference point in terms of whether we do more or less. In my opinion children are substantially under-treated in the UK.”
I’m with Kerre Woodham on this one – I have personally known too many kids who have been helped by grommets. I would hate to see any cuts to what is often a vital procedure – especially when we could be starting with protruding ears instead. Last word (from the same piece as the above quote) to Labour’s Maryan Street:
Labour’s health spokeswoman, Maryan Street, said reducing the number of grommet operations for children – without a direct investment in measures to reduce the need for the treatment – would be a false economy that led to “more kids sitting in class unable to listen and learn”.
Exactly.
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