By Anusha Bradley of RNZ

Private hospitals may be asked to help pay for surgical trainees they take on during outsourced elective treatments.

Doctors have raised ethical and logistical concerns about allowing publicly paid surgical registrars to essentially provide free labour while training and assisting on less complex elective procedures outsourced to private hospitals for profit.

The country’s largest private hospital provider, Southern Cross Healthcare, said it was willing to contribute towards training costs.

Currently, surgical training can only occur in public hospitals. Orthopaedics is the only specialty that has a national agreement with private hospitals to train registrars, which has been in place for just over a year.

Health New Zealand said it hoped to set up similar agreements for other specialties with radiology, pathology and obstetrics and gynaecology likely to be next off the rank.

In a November briefing to former Health Minister Shane Reti, Health NZ floated the idea of making private hospitals help pay to train registrars, and even make it a condition of outsourcing contracts.

Allowing publicly funded registrars to work in private hospitals “amounts in some regards to a cross-subsidy of the private healthcare system by Health NZ which bears the full costs of training, but then loses capacity to the private system,” the paper said.

It suggested “commercially reasonable cost-sharing models” to ensure “value for the public health system”.

A March briefing to Health Minister Simeon Brown noted the New Zealand Health Workforce Plan had a specific action to reach an agreement with private hospitals to allow training in private settings, and “that a sustainable funding model is established to facilitate such training”.

In a statement, Southern Cross Healthcare chief executive Chris White agreed increased collaboration between the public and private sectors should include sharing the costs of training specialists.

“Health New Zealand has clearly signalled its expectation that under this new way of working together, we must address how we can collectively support and deliver training, staffing and investments in infrastructure.”

But to make this “feasible” to private hospitals, it was “essential” that it was underpinned by multi-year contracts and “committed case volumes”, he said.

“This enables responsible planning for higher operational costs and capital investments required.”

The New Zealand Private Surgical Hospitals Association said its 34 members – who performed 67% of all elective surgeries – were open to allowing more training to occur in their hospitals.

“It’s just making sure we get the settings right and that it works well for all parties involved,” association president Blair Roxborough told RNZ.

“Our current contribution is by way of providing access to those training surgeons, using the orthopaedic association model that works well. Looking to the future, we remain open to working together with Health New Zealand on how we collectively support training under multiyear arrangements ”

Private hospitals already trained nurses, anaesthetic technicians and allied health employees, he said.

-RNZ