Ministry of Health’s high cost treatment pool spends $26m sending Kiwis overseas for medical treatment

Almost $26.5 million has been spent providing Kiwis with life-changing medical treatment not available in New Zealand.

Countless New Zealanders have been forced to look to the private sector or even overseas for treatment for rare conditions not available through the public health sector.

While many have to come up with the cash themselves, each year the Ministry of Health agrees to fund a handful of expensive life-saving and life-changing treatments.

Data released to the Herald shows the ministry’s High Cost Treatment Pool has spent $26,475,302 (excluding GST) funding such treatments between July 2009 and June 2020.

Treatments approved between 2011 and this month were for various hearing, brain, eye, lung, genitourinary and heart conditions, as well as, gender affirming surgeries, treatment for twin-twin transfusion syndrome, stem cell treatments and several radiation therapies for cancer, Ministry of Health chief medical officer Dr Andrew Connolly said.

He said most applications were for treatments not available in New Zealand with the most common overseas locations being Australia, the United Kingdom and the United States of America.

About 10 to 15 people receive funding each year.

For people like Melody Klein Ovink, the fund is life-saving.

The 24-year-old was diagnosed with a rare condition called spinal arteriovenous malformation in September last year.

The condition means she could drop dead or become paralysed at any moment but doctors in New Zealand told her there was no one who could operate on such a rare and complex condition.

Not content to live with that, the Tauranga woman contacted the Barrow Neurological Institute in Phoenix, Arizona which said they would operate.

From there began a mission to raise the $470,000 to fund the trip, procedure and rehabilitation.

As part of that Klein Ovink made an application to the High Cost Treatment Pool but was not holding out much hope they would agree to pay for such a costly operation.

Finding out in May that it had been approved came as a huge, but welcome, shock, she told the Herald at the time.

It meant her parents could stop looking into re-mortgaging her house and Klein Ovink would not be forced to take out a personal loan.

Oamaru woman Nicole Williams also benefited from the fund in December 2018.

Then 20 years old, an annual eye check found a mole on her eye she had been monitoring since she was seven had turned cancerous.

Her options were removal of the eye or a trip to England for specialist treatment she could not get here.

She applied to the High Cost Treatment Pool for funding for the proton beam radiotherapy in England and less than four months later she was undergoing the procedure.

But not just anyone can apply.

Applications were only accepted from district health board specialists with supporting
documentation and recommendations for treatment, Connolly said.

“Before the application is made there has usually been a lot of clinical discussion between the referring clinicians and the proposed treatment provider.”

To be considered, the treatment must only be available in a private hospital or outside New Zealand and only New Zealand citizens or permanent residents are eligible.

Medicines New Zealand chief executive Graeme Jarvis said the High Cost Treatment Pool only provided access to medicine if it was part of a larger treatment plan.

Jarvis said he believed the ministry needed to broaden the scope of the pool to allow patients to access cost-effective medicines which may be the primary or only treatment option available to help them with their health condition.

Alternatively, he said a rapid access scheme would allow patients access to drugs proven to be safe and affective overseas and potentially speed up Pharmac’s funding process.

Under the UK’s scheme more than 35,000 patients had registered to receive treatment with 75 medicines covering 138 different cancer indications in 2020, he said.

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