A pilot programme at Auckland City Hospital started in April and there’s no financial data available yet.
Auckland’s hospitals topped the list – with Waitākere, North Shore and Middlemore hospitals giving out 73,000 vouchers worth $7.2 million between them. A bit further south, Waikato gave out 31,000 vouchers worth $4 million.
The system is not offered at Nelson, Wairau, Christchurch, Grey, Oamaru, Lakes District, Gisborne or Whanganui Hospital emergency departments, while Dunedin stopped giving them out in late 2022.
Australasian College of Emergency Medicine New Zealand Faculty chairwoman Dr Kate Allan said the numbers reflected the scale of demand on EDs – pointing out they were a very small percentage of the presentations to emergency departments in this time.
New Zealand Faculty chairwoman for the Australasian College of Emergency Medicine, Kate Allan. Photo / Jason Dorday
She said it was about giving patients another option, because those less urgent ones end up waiting the longest for care.
“It’s almost about educating our patients, community and public also about the alternatives to care, other than emergency departments, because we don’t need to see everyone.”
Health New Zealand planning funding and outcomes – hospitals director Rachel Haggerty said reducing pressure on emergency departments was a key priority with hospitals experiencing growing demand and seeing more people than ever before.
She said some hospitals, such as those in Waitematā and Waikato had had the voucher system in place for almost a decade, helping to ensure EDs are reserved for those truly needing acute hospital-level emergency care.
“The way it works is that people presenting to ED may be offered a voucher once they have been triaged and clinically assessed with a medical condition that can be safely managed in an urgent care clinic. They are given the option of being able to attend a nearby urgent care clinic or waiting to be seen at the emergency department.
“Patients who are issued a voucher and do not present to the urgent care clinic receive a reminder message to seek medical care if their symptoms persist.”
Association of Salaried Medical Specialists executive director Sarah Dalton said the voucher system speaks to the postcode lottery and financial barriers to care.
“What about all the people who go to urgent care without a voucher? Who pays and who doesn’t pay? And what about the people who go to urgent care and pay and then are referred to the ED?
“It’s a little bit shambolic, I think, and a little bit piecemeal.”
Association of Salaried Medical Specialists executive director Sarah Dalton.
Dalton said she was aware of a person who went to an ED, went home after a couple of hours without being offered a voucher, later went to an urgent care clinic and paid $120 to be seen and then was referred to the hospital.
She said it also raised questions about whether more people were going to go to emergency departments to collect an urgent care voucher – to avoid paying the cost.
Dalton said there were also questions about the unevenness of voucher distribution.
“Who decides who gets a voucher? Who decided when that’s appropriate? And what does that mean for the urgent care provider down the road, many of whom are really busy as well?”
Northcare is an accident and medical centre on Auckland’s North Shore. Its founder, Peter Boot, said the voucher system was “slightly crooked” with the vouchers only able to be used at some clinics.
But overall, he believes emergency departments could be more efficient.
He said he messaged Health New Zealand Board chairman Lester Levy earlier this year setting out how a doctor who worked part-time for him is expected to see four to five patients an hour, but when they work at a hospital emergency department, they are expected to see seven patients in an eight-hour shift.
Northcare Accident and Medical founder Dr Peter Boot. Photo / Dean Purcell
Boot said the hospital was supposed to be secondary care and GPs and private A&Es the primary care.
“We are supposed to be seeing everybody, screening everybody and only sending the really difficult and hard stuff which requires specialist attention through to the hospitals.”
But he said a lack of funding for primary care means people could not afford to go there any more, so they “flood the hospitals with trivial complaints” and hospitals get bogged down.
Boot said the whole system needed to change.
He said primary care needed more funding, because the clincis could “steam through the patients and then send the hard stuff to the hospital”.
At the same time, he believes hospitals have a “huge amount of unnecessary investigations and duplications” and need to streamline their processes.
Dalton wants to know what will be done to support the places that don’t offer vouchers, and floated the idea of setting up publicly funded, free-to-access, urgent care clinics, to take some pressure off EDs.
Haggerty said they were working to deliver new and improved urgent and after-hours services in areas that needed them most and encouraged people to use services such as Healthline if they were unsure where best to present.
This year’s Budget included $164 million over four years to expand urgent and after-hours healthcare services across the country.
Allan believes when it comes to alleviating the pressure on emergency departments, the vouchers aren’t going to fix it “no matter how many you give out” because they’re helping manage those less urgent patients, and the most pressure comes from those presenting with complex issues.
But she says the vouchers make a difference to the prolonged waits faced by people with more minor issues.
“Every little bit helps. It’s about spreading the load across the whole health system because we are all busy and it’s making sure our patients are able to receive timely care in the most appropriate place they can – and sometimes that’s not an emergency department.”
The latest Health New Zealand figures on the Government’s health targets show that, in the April to June quarter, 73.9% of patients were admitted, treated or discharged within six hours.
That’s up from 71.2% last year, as the Government aims to get that figure up to 95%.
Danica MacLean is an Auckland-based news director and senior reporter for Newstalk ZB, with a focus on health stories. She joined NZME in 2017, initially working for the Northern Advocate before switching to radio. She has previously worked for Stuff in Northland.