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A Messy Reality: An Analysis of New Zealand’s Elective Surgery Scoring System via Media Sources, 2000–2006

The Issue

In the 1990s, New Zealand launched a program to manage its long waiting list of patients needing elective surgery. The program requires clinicians to score patients using standard criteria and subsequently schedule qualifying patients for surgery. To assess the model's effectiveness, researchers led by former Commonwealth Fund Harkness Fellow Sarah Derrett examined more than 1,000 newspaper stories written about the booking system between 2000 and 2006, looking for evidence of regional variation in performance and for public and political reaction to the system.

What the Study Found

  • Staff shortages in certain medical specialties, in addition to New Zealand’s inability to offer internationally competitive salaries, undermined the country’s capacity to provide timely or adequate volumes of services. Staff shortages affected some hospital regions more than others.
  • Although the government periodically announced funding infusions following high-profile incidents of waiting list growth or incapacity to provide services, some hospital regions continued to operate at a deficit, further restricting patients' access to services.
  • To meet government requirements that patients receive services within six months, local hospital boards routinely removed eligible patients from waiting lists when they lacked the capacity to treat them. 


New Zealand’s central government may need to become more closely involved with local management and policy to ensure equity and consistency in access to elective surgery. Other countries considering developing similar systems should exercise caution, the authors say.

Publication Details



S. Derrett, K. Cousins, and R. Gauld, "A Messy Reality: An Analysis of New Zealand’s Elective Surgery Scoring System via Media Sources, 2000–2006," International Journal of Health Planning and Management, published online July 20, 2012.