Mind the Gap: ethical issues of private treatment in the public health system

The funding of expensive new cancer treatments is a difficult health policy issue in New Zealand and around the world. Since the public health system cannot afford to fund every new treatment, complex decisions must be made about which treatments to fund publicly, and whether and how to make unfunded treatments available to people who may wish to fund them themselves. One recent proposal is that unfunded treatments be made available to patients privately through the local public hospital. Although ultimately declined by the health minister, this proposal merits serious debate, since it is likely to continue to attract attention as a policy option. While the integration of public and private delivery systems has clear benefits for patients with the means to purchase additional treatments, its overall effect may be to exacerbate existing inequities in the New Zealand health sector. This paper briefly explores the wider ramifications of such schemes as part of the ongoing public discussion that should inform the development of health policy on this issue.