National funding for elective surgery is not fair and the Southern District Health Board is missing out on more than $8 million a year, recently departed chief executive Brian Rousseau argued.
However, altering the system as he suggested would mean three Auckland DHBs would lose a total of more than $32 million this year.
Documents released to the Otago Daily Times under the Official Information Act show the long-term concerns raised by Mr Rousseau with the National Health Board and Ministry of Health about the impact of population-based funding on the Southern DHB.
The documents suggest Mr Rousseau considered the board had reached an understanding with the NHB last year on the electives funding which would allow it to add $8.1 million to annual revenue in its future budgets.
But, in a report which was to have been considered by the Southern board last month but was later withdrawn, Mr Rousseau said the money was removed from the future annual plans on advice from the NHB, while he was away on leave in May and June.
The issue Mr Rousseau wanted addressed relates to the way electives funding is allocated.
The problem dates back to 2006-07, when targeted funding for elective surgery was introduced to boost elective surgery across the country.
All boards were required to increase the amount of surgery they were doing and paid to do extra.
However, the base from which they increased was not related to their population, but to the amount of surgery they were already carrying out.
Some boards were doing less than their population share, while the then Otago board was delivering well above it.
Mr Rousseau argued that the base should have been set with regard to how much surgery was being delivered per head of population.
The board was given a $3 million annual top-up to compensate for its over-provision, but this was not considered adequate and since 2009 it has been keen to see this removed and equity ensured by basing all boards' additional elective services on a population share.
Figures he produced for this financial year showed if electives funding was allocated according to population, Southern would be more than $11 million better off.
The board, which is expecting a deficit of about $10.4 million this year, would gain the most under the population-based system suggested, followed by Bay of Plenty ($6.7 million) and Nelson Marlborough ($5.9 million).
The biggest loser would be Auckland DHB ( $14.3 million), followed by Waitemata ($9.6 million) and Counties Manukau ($7.9 million).
Thirteen of the country's 20 boards would have more funding.
Correspondence shows that in March the NHB advised it was prepared to reduce the amount of increased surgery required, saving the board $3.7 million this year.
Ministry of Health team leader of funding and monitoring Jane Potiki later explained that to do what Mr Rousseau sought could not be achieved at once.
If there was an alignment with population share, some board bases would reduce while others would have to increase.
"To attempt this would have put the electives programme at risk."
Some boards would not have been able to increase their base and would therefore not deliver any additional surgery, while other boards would be delivering the same level of surgery but receiving funding for extra operations.
A transition period would be required for boards severely impacted by the change Ms Potiki said.
A response to questions posed to the NHB about some of the issues raised by Mr Rousseau will be available this week, NHB sector relationships and engagement principal adviser Stephen Addison said on Friday.
