Some Dunedin Hospital cancer patients have already paid for unfunded treatment - with the consent of senior management.
Unfunded intravenous drugs are allowed to be administered after 5pm if patients pay, but district health boards' approach to such treatment has been inconsistent.
• Call to avoid drug-funding 'games'
This is revealed in a background document, made public this week, to accompany the Otago and Southland district health boards' controversial five-page "Bridging the Gap" consultation paper.
The paper sets out the option of public hospital patients paying for extra treatments.
The paper says some boards prevent clinicians from providing intravenous unfunded treatments, but turn a "blind eye" to the prescribing of patient-funded oral chemotherapies.
The 12-page background document was presented to the boards last year by the Southern Blood and Cancer Service's medical oncology and haematology consultants, when the issue was considered behind closed doors.
The matter became public only when the consultation document was posted, without prior publicity, on the boards' websites on December 11.
Oncologist Dr Chris Jackson, and lead author of the background paper, said the proposal was designed to help patients access unfunded cancer treatments without incurring the expense and disruption of having to travel to other centres.
He cited the case of one patient who travelled from a provincial town to Palmerston North for private chemotherapy treatment on a Tuesday.
"We could have given him the same treatment in Dunedin, but we were not allowed to."
The background paper noted there was no mechanism to account for, monitor or prevent an oncologist from prescribing patient-funded oral medicine to be collected from a community pharmacy.
There was no clear policy or defined structure that enabled staff to routinely offer unfunded treatments and ensure no negative effect on nursing and the medical day unit where outpatients receive chemotherapy.
The paper said patients who could not afford to pay were likely to feel "let down and disenfranchised" alongside those who could, and that such patient perceptions and feelings were not to be taken lightly.
Accordingly, the use of a separate four-bed ward would ensure patients receiving different treatment regimes would not be side by side.
The background paper suggests a pilot for top-up patient-funded cancer drugs, although this is not specified in the consultation document.
Board chief operating officer Vivian Blake said the aim of the consultation was to seek public and staff views on the provision of top-up treatments, not a pilot.
The consultation document was deliberately general, rather than specific to cancer drugs, because there could be other treatments or conditions where top-up drugs and services could be available and "we did not want to have two sets of rules within the hospital".
If the public and the staff supported the proposal, and the Minister of Health agreed, the boards would conduct a pilot around cancer treatments.
At the end of that, "we will need to consider the broader implications for the hospital and health care sector".
The background paper acknowledged the provision of privately paid care in a public setting was a contentious issue which "cuts right through the principles of equity - that every person should have access to health care based on their need, not their ability to pay - and personal autonomy - that people should be free to spend their money as they choose, without losing their access to treatments and services to which they are entitled through their tax contributions".
There was no New Zealand legislation that specifically prohibited provision of private care in public health services, and there were protocols about this agreed nationally in October 2000, the paper said.
These protocols had been interpreted and applied variably across different district health boards.
There was no consistency in how boards handled the situation of a clinician wishing to prescribe and a patient willing to pay for an unfunded treatment.
"This effectively creates an inequity of patient access to treatments depending on where they live [i.e. postcode prescribing]."
In the absence of clarification on policy in this area from the Ministry of Health, district health boards needed to show "leadership and innovation in identifying fair and responsible ways to allow patients to self-fund aspects of treatment" where public funding was not yet available.
The consultation document has attracted criticism from the New Zealand Nurses Organisation, the Association of Salaried Medical Specialists, and the Labour Party.
The board has received 48 submissions so far on "Bridging the Gap".
The consultation period ends on February 2.
