The cost of everything and the value of nothing: the first corrective steps are to stop ignoring and start measuring the unmet secondary elective healthcare need

We wish to congratulate the authors of a recent editorial in this journal (“The cost of everything and the value of nothing: New Zealand’s under-investment in health”¹), one of whom is undoubtedly among the best-informed authorities on Aotearoa New Zealand healthcare economics.² We were delighted that they specifically mentioned unmet healthcare need in their editorial. This is one of the largest and most obscured problems in our healthcare system.³

Since the 1990s, successive governments have controlled the provision of secondary elective healthcare using tools such as financial and clinical thresholds for healthcare access.⁴ The results have been that: i) currently reported waiting times for assessment and provision of healthcare provide no measures whatever of effectiveness of healthcare systems or of unmet need, ii) unmet secondary elective healthcare need (USEHN) has undoubtedly been steadily and silently increasing over the years, as evidenced by growing interest in developing charity hospitals around the regions,⁵ iii) longer delays result in later presentation, with more advanced disease and worse prognosis, and iv) hence we are burdened by higher costs, higher mortality, lost productivity and increased pressure on our already stressed acute healthcare systems.

We have made numerous attempts to encourage the government to measure the quantum of USEHN through proven population survey methods that allow comparisons across ethnic and socio-economic groups, and permit international benchmarking standards to be established for Aotearoa New Zealand.^6,7 Our attempts have always been frustrated by health officials; our last approach was turned down in a letter from the minister of health on 8 August 2024. He claimed that a recent general practitioner (GP) survey told them what they need to know.⁸ He forgets that unmet primary care need does not provide data on USEHN and, even more crucially, the lowest socio-economic members of the population cannot afford to attend a GP, despite having the highest levels of unmet healthcare need.