One of the issues dominating newspaper headlines over the past several weeks has been the performance of Labtests, the new provider of medical laboratory services in the Auckland region. We’ve heard about long waiting times for tests, long waiting times for urgent lab test results, difficulties in accessing testing facilities and errors in tests conducted and reported. These are entirely predictable consequences from the contracting approach pursued and, in fact, the Green Party did predict them.
Of course this initial period of Labtests’ operation was always bound to be subject to intense scrutiny, both arising from ‘hypervigilance’ on the part of funders and an anxious public, and from an intent on the part of the previous provider, DML to oust Labtests and reclaim its previous role. Had this level of scrutiny been applied to DML’s performance for a comparable period in the past, it remains to be seen how many errors or adverse events would have been detected.
Nonetheless, some deterioration in service quality seems incontrovertible. It seems clear that doctors have experienced unacceptable and dangerous delays in accessing test results and speaking with pathologists. The reduction in collection centres (certainly justifiable in some areas) has resulted in whole areas being left without collection centres. Some collection centres are in entirely inappropriate locations (for example, the one I saw on Waiheke Island – the only one – that requires scaling two steep flights of stairs to get in).
Achieving savings by cost-shifting
Certainly saving $15 million on the contract (if indeed the promised savings are realised), to be made available for other health services, is not to be sneezed at, and at least one columnist has suggested that the previous service was inappropriately ‘gold-plated’. However, where a provider is able to reduce its price for a service by reducing access to that service or compromising timeliness then these savings are achieved by shifting cost to users of the service, and thus shifting the boundary between publicly and privately-funded health services, without consultation with the public.
This doesn’t just apply to the health sector, but to all public services. We need to find ways to ensure that we receive as much value for money that we can where services are contracted out, without achieving this simply by shifting costs onto those members of the public who need those services.