Under 'transitional access' private patients won't have to shift to the public system for 12 months. Photo: 123RF
A move to allow private patients to access publicly-funded cancer drugs threatens to increase wait times for those in the public system, warn senior doctors.
Under "transitional access", which comes into effect on 1 July, private patients who are already receiving treatment - or about to start treatment - with a newly funded medicine will not have to shift to the public system for 12 months.
Associate Health Minister David Seymour, who has championed the rule change, said it would lessen stress on private patients by enabling continuity of care, and pressure on the public system which would no longer have to deal with a sudden influx of patients.
However, the move has been criticised by opposition politicians as "a subsidy for private insurers", which already cover the cost of medicines newly funded by Pharmac, and of little benefit to patients.
The Association of Salaried Medical Specialists, which represents 6500 senior hospital doctors and dentists, said its members working in oncology and haematology had "significant concerns" the change would widen inequities for patients.
Change will create 'two-tier' waiting list
In a letter on 13 June to Pharmac's acting chief executive Brendan Boyle, the union's director of policy and research, Harriet Wild, quoted a briefing to the minister saying the policy change "would not increase volumes of cancer medicines provided in New Zealand, as only the location of treatments will change".
"It will simply shift some of the existing capacity to the private system, where patients will need to fund infusion costs out-of-pocket," Wild wrote.
"There will be pressure on the public system to ensure a smooth transition in treatment regime, which may mean delaying treatment for other people already waiting on the public list and unable to self-fund to start in private.
"This potentially creates a two-tier waiting list and a system where those with more financial resources, will be prioritised for treatment."
Furthermore, the shift of resources and inevitable increase in demand was likely to speed up the exodus of staff to the private sector, making public waiting lists even longer.
In a written response to RNZ's questions, the Health Ministry said the transitional access arrangement was intended to support "continuity of care".
"This policy is designed to support patients who began their treatment privately when there was no publicly funded option for their medicine at the time of their treatment decisions.
"Transitional access also supports the wider aim of easing pressure on the public health system by allowing private patients to stay in private care, which may contribute to reduced wait times, costs and pressure on other resources in the public system for the benefit of all patients."
The spokesperson said it was unlikely the rule change would lead to a loss of oncology staff working in the public system, as it was only targeting "a small number of patients".
Health NZ director for hospitals, planning, funding and outcomes Rachel Haggerty said Health NZ was working to ensure every region had the capacity to deliver the extra funded medicines.
"Funding provided in 2024/25 has covered the provision of these extra medicines along with supporting a coordinated, international recruitment campaign for oncologists and pharmacists.
"Recognising that uptake of the medicines will increase steadily from now until mid-2026, the government has allocated $60 million in 2025/26 to enable Health NZ to increase capacity and develop the facilities, staff, and systems to provide cancer treatment closer to home for more people."
Minister signals broadening access further
A "back-pocket Q&A" provided to Seymour ahead of a Cabinet meeting on April 7 noted that the current eligibility criteria in the Pharmaceutical Schedule (excluding patients in private settings) was "designed to ensure public funding for medicines was prioritised for those managed in the public health system for cancer treatment, assessed by need, rather than public funding supporting those who chose to access treatment in private facilities.
"Often the private treatment is funded from private health insurance that people have paid premiums into."
In the same document, the minister said there was no plan to expand the policy to include other types of medicines or treatments "at this stage".
"With that said, I've asked the Ministry [of Health] to do further work in this area to explore the possibility of broadening access to all publicly-funded medicines in private facilities - not just newly funded cancer medicines.
"I encourage the private health providers and insurance companies to work closely with the ministry to support their understanding of how this might work in practice."
Wild said opening access to publicly-funded drugs even wider would pull more staff away from the public system, reducing access for the majority who relied on it.
"That would establish a system where a patient's ability to receive timely cancer care would depend on whether they could afford the out-of-pocket infusion costs."
Pharmac's Budget boost needs 'back up'
The government's 2024 Budget boost to Pharmac to widen access to medicines for patients had not been accompanied by extra resources for Te Whatu Ora to deliver the treatments, when public oncology services were already swamped with demand, Wild said.
"Our members are increasingly needing to manage deteriorating patients, who are unable to access chemotherapy infusions in clinically acceptable timeframes.
"This is unacceptable and represents a significant failure to invest in a planned and co-ordinated way to enable the public system to meet the needs of cancer patients, including those eligible for newly funded cancer medicines.
"Whenever a new cancer drug is funded, it must be accompanied by an increase in the full package of care (staffing, infusion space, pharmacy) so that patients can actually receive the medicines within clinically acceptable timeframes."
The Health Minister and David Seymour's office have been approached for comment.
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