This is the sixth story in an RNZ series about the growing pressures and profits in the fraught field of radiology, the jammed bottleneck that most patients must pass through.
Photo: 123RF
Towns trying to save their medical services can take a boost, and a warning, from Dannevirke.
The lower North Island town is better off than those that have lost their medical services completely - but the free ones it still has are on a knife-edge.
Locals had been able to get x-rays and ultrasound scans mostly for free via a public contract at a privately-owned practice for 25 years until the blade dropped.
"Why take it away from us?" asked community board chairperson Pat Walshe.
He was one of the first to find out, back in April.
"A friend of mine was looking for a scan," he said.
"And they come to me because people seem to bring their problems to me, being the chairman of the community board.
"And she couldn't pay, she wasn't paying $260."
People's aches, pains and diseases did not go away, but the people themselves did, once they found out.
"We saw a dramatic downturn in people accessing the services," said Sam Chapman, operations manager at Tararau Health Group that does the scanning. It is just over half owned by Omni Health, which did not respond to RNZ's requests for input.
"We had a lot of people still turn up expecting it to be funded like it had been previously, and of course wasn't."
Māori, Pasifika and those with a community services card still got scans for free. Most didn't.
"People, to access some funding, were having to go through to Palmerston North Hospital. So it's a big trip and adding pressure to secondary care when they're already overstretched," she said.
Unfortunately for Dannevirke, Palmerston North Hospital has so few radiology staff that its department lost its accreditation over a year ago, and some services have had to be outsourced to private providers - of which there will soon be more.
Private investors are funding new private hospitals with full radiology services to the south and north of Dannevirke, in Palmerston North and Hastings.
The radiology at Hastings is subcontracted to Canopy Healthcare, a decades-old New Zealand group that a massive European private equity firm recently took a large stake in.
As one public door closes, another private door is opening.
But Dr Victor Luca of Grey Power in Whakatāne, who is lobbying against this, said only just over a third of people had private health insurance.
"So by definition we have a two-tier system of haves and have nots," he said in a research paper.
Luca has won backing at national level for Grey Power to lobby to "halt the ongoing privatisation of our health system without a sound economic business case".
"Numerous OIA requests to the MoH [Health Ministry] has convinced me they don't have a business case," he said.
"They don't even seem to have workforce numbers.
"My data suggests that slowly but surely we are heading in the direction of the US, in the false belief that private is more efficient and results in better outcomes."
Mayor of Tararua District Tracey Collis did not know about the scanning charges back in April until she took a call from Pat Walshe.
Mayor of Tararua District Tracey Collis Photo: RNZ / Tom Kitchin
She was "shocked" and began a fight back.
"It was even raised in a meeting a community meeting here with the Minister Grant Robertson, you know, because everybody knew somebody that had been impacted by that," Collis said.
It has worked, this time.
"So as soon as the news came through it was in our newspaper, it was across Facebook, and people were just absolutely thrilled."
But the reprieve may be only temporary - Health New Zealand uses the terms "in the interim" and "for the near future".
The charges had been "a trial" of a new way of access, said general manager of communities, localities and commissioning for Te Whatu Ora MidCentral, Deborah Davies.
"Following feedback from our communities, community-delivered radiology services returned to being free in the interim for all patients in the Tararua locality, as well as Horowhenua and Ōtaki, and will remain this way for the near future," she said in a statement to RNZ.
Why was free scanning cut in the first place?
"Some radiology scans are not always the best course of action to help a patient's treatment," Davies said.
"By prioritising the scans that get the best results for our patients, we can help increase access to scans, as well as decrease wait times."
Meantime, a new review of radiology has been completed in Dannevirke, but it's not out yet, Health NZ said.
The mayor Tracey Collis sees it as another review she and the town have been left out of.
Sam Chapman said locals had a lot to lose and a lot to say.
"The thing that we try and get across to our patients and to our funders is that the staff that work here, live here.
"We're well connected to the our community, so we are well placed to advocate for them."
The private-public model, while sometimes "confusing", was also flexible, she said.
"Hopefully, the health reforms are pushing towards that locality approach.
"So hopefully, given our location, we'll be able to keep the services. But it's not a guarantee."
Pat Walshe can't quite believe it.
"I tell you what," he said, "if that happens, if they bring the price back, people are not gonna go there, the people that work there are probably going to lose their jobs. It's just not on."