Planned care, covering a wide range of scheduled medical and surgical treatments, is under immense pressure globally. Commonly referred to as elective care, this term has unfortunately contributed to a damaging misconception: that such procedures are optional.

In truth, delayed access to joint replacements, hernia repairs, and cataract surgeries causes prolonged suffering, loss of independence, and worsened disability. The current model is failing many and failing them unequally.

Why Planned care must be prioritised, not optional

In Aotearoa, New Zealand, people living in rural areas, experiencing socioeconomic deprivation, or identifying as Māori, Pacific, or disabled, wait longer and face systemic barriers to access. The Office of the Auditor-General has highlighted these inequities, showing that regional inconsistency, poor visibility of unmet need, and incomplete data on disabled patients all contribute to a fragmented system.

Under the Pae Ora (Healthy Futures) Act 2022, Health New Zealand is mandated to deliver equitable services. Yet, access remains deeply uneven. Planned care must be reframed as a core component of health equity, not a nice-to-have.

Short-term fixes are exacerbating long-term inequities.

The government has turned to private sector outsourcing and surgical hubs to address long wait times. While these strategies can improve throughput for low-complexity cases, they risk entrenching inequity.

Patients with comorbidities or frailty, who are often the most in need, are frequently excluded, not due to clinical need, but because they don’t “fit” into simplified private sector models. This creates a de facto tiered system: the healthy and insured at the front of the queue, while the public sector manages complex cases with increasingly strained resources.

Graph showing the counts of publicly funded discharges by private or public hospitals. Showing Steadily rising count of Private Hospital Discharges between 2011 to 2024 compared to steadily declining numbers of public hospital discharges.
Counts of publicly funded hospital discharges, by private or public hospital type over time in New Zealand
Source: Te Whatu Ora

What International Health Systems are doing differently

Globally, many countries have adopted multi-pronged approaches to reduce waiting times effectively. A comprehensive systematic review has identified seven high-impact strategies, including:

  • Referral optimisation
  • Equity-focused patient prioritisation tools
  • Cancellation prevention mechanisms
  • Improved perioperative care

Systems that employed transparent referral frameworks incorporating clinical and socioeconomic criteria achieved the best results. In contrast, blunt tools like wait time targets often had unintended consequences, such as reduced care quality or patient gaming of the system.

A model of the process by which visible “outpatient” and “inpatient” waiting times for publicly-funded surgery arise
Source: OECD Waiting Time Project

Progress at home: Turning waitlists into preparation lists

There are positive signs locally. Initiatives like perioperative optimisation, smoking cessation, and physical prehabilitation are making a measurable difference.

Framing waitlists as preparation lists enables better surgical outcomes and opens up crucial opportunities for shared decision-making, particularly for older adults or those with complex conditions.

A better understanding of planning and implementation of strategies is critical to achieving desired organisational changes. The common implementation levels for each type of strategy or intervention are:
Source: Rathnayake, D., Clarke, M., & Jayasinghe, V. (2024). Global strategies to reduce elective surgery waiting times for sustainable health outcomes: a systematic review. Hospital Practice, 53(1).

A systemic solution: Build for equity, not expediency

The way forward demands more than patches. Short-term outsourcing may be politically palatable, but it diverts workforce capacity and training opportunities from the public system, ultimately weakening it.

Access to care should not depend on the ability to pay or the simplicity of the case. True reform will require:

  • Nationally consistent clinical thresholds
  • Equity-first prioritisation frameworks
  • Integrated referral pathways
  • Transparent monitoring and reporting
  • Expanded prehabilitation programmes
  • A robust, well-resourced public system that can train, retain, and treat

The Path Forward: Data-Led, Equity-Driven Design

Planned care must be recognised as a critical service, not a luxury. Its future depends on intentional, data-informed, and equity-centred design.

If we fail to reform with these values at the heart, the most vulnerable in our communities will remain unseen, unheard, and untreated.

Authored by Tom Varghese, Global Product Marketing & Growth Manager at Orion Health.

References

Auditor-General of New Zealand. Providing Equitable Access to Planned Care Treatment: Summary. June 2025.

Centre for Interdisciplinary Research, University College Dublin, and Queen’s University Belfast. “Global Strategies to Reduce Elective Surgery Waiting Times for Sustainable Health Outcomes: A Systematic Review.” Hospital Practice 53, no. 1 (2025): 2435802. https://doi.org/10.1080/21548331.2024.2435802.

McNally, Scarlett. “Tackling a Huge Surgical Waiting List Needs a Different Approach.” BMJ 380 (2023): p162. https://doi.org/10.1136/bmj.p162.

Dalziel, Lianne. “I’d Never Have Got My Operation in Broken Public Health System.” Newsroom, July 9, 2025. https://newsroom.co.nz/2025/07/09/lianne-dalziel-public-v-private-health-system/.

Health New Zealand. OIA Response HNZ00081584: Outsourcing Elective Treatments, March 2025.

Health New Zealand. Principles for Outsourcing Planned Surgery Waiting Lists, February 2025.