New Zealand's Health Care?

Pete L's picture
Submitted by Pete L on Tue, 2005-12-06 05:45

Since there are so many from NZ on this site, I was simply curious as to what the role of government is in your country's health care. Does the government fund health care? If so, is it a single payer system or is there both private and public insurance?

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Interesting statistic on the

Ross Elliot's picture

Interesting statistic on the radio today. Only 19% of GPs in NZ are under the age of 40. That seems low to me. If you accept that many NZ doctors go overseas in search of greener pastures, that would make perfect sense.

I'm assuming that doctors gravitate from general practise to other areas and not vice versa. If that's not the case then perhaps it's normal that GP numbers increase by age.

Thanks, Phil. Valuable info.

Ross Elliot's picture

Thanks, Phil. Valuable info. I shall use it well & with discretion Smiling

The three waits

Phil's picture

First wait is to be seen by a consultant at a hospital clinic, very variable

Second wait is for those who would benefit from surgery but do not achieve enough points to get done. They are filed away in a holding pattern called "care and review" (I used to call it no care and rot but one of my small victories is that they are now reassessed on a six monthly basis, at least in my department) and some of those even get to the third wait. This can be years.

Third wait is the official waiting list. Very variable, the longest one I have cleared waited six years for surgery. The surgery was a technical success, the patient was delighted. Unfortunately she died of old age three months later.

Thanks, Phil. Mum *is* on

Ross Elliot's picture

Thanks, Phil. Mum *is* on the public list. What are the three lists you mentioned? And next week the agitation starts. We've got a brand new National MP here who blew Jim Sutton away by 12,000 votes. It's time to see if she can put her money were her mouth is. And, time to start *using* the system instead of working against it--in this case, anyway Smiling

Hi Ross,Certainly making

Phil's picture

Hi Ross,

Certainly making private medical insurance tax deductible would a huge step forward. It's my understanding (from talking to other surgeons who have worked there) that the Australians have such system in place and that it works very well indeed.

As for helping your Mum get her phaco done I have seen three techniques employed with varying success. 1, Pay for the surgery outright ($2,500 to $3,500) 2, Pay to see an ophthalmologist privately ($98 to $150) and get them to put your Mum on the public waiting list (she will at least dodge the first of the three waiting lists) 3, Agitate. It leaves a sour taste in my mouth but truly the squeaky wheel gets the grease…

Hi, Phil

Ross Elliot's picture

Hi, Phil

Good to hear from someone working within the system.

I'd be interested to know if you're as suspicious as I am of the reason why successive governments have not allowed tax deductibility for medical insurance. I know Winston Peters campaigned on that in the last election but I'm not sure if it was a part of National's policy.

My sense of it is that since Kiwis have such a high uptake of insurance then any deductibility would serve to enrich & therefore grow the private sector at the cost (read: benefit) of downsizing the public sector. It would also make those who have always had insurance better off and allow those who haven't been able to afford it to finally partake. And it shouldn't be a deductible that reduces your income, it should reduce your tax payable. It seems to me that this would transform the NZ healthcare system dramatically within only a few years.

The same argument holds for education fees, but that's another thread Smiling

NB: any tips on how I can move my mother up the waiting list for a cataract op? They said six months but it's been a year & no sign of progress. The family is thinking of pitching in so she can go private.

Waiting to get on the waiting list for the waiting list

Phil's picture

I am an Ophthalmologist in New Zealand, I work both in both the public and private sectors, and I think your summary of medicine in New Zealand is a fair one.

There are many factors at play squeezing our public health system, but two come to the forefront of my mind.

1, The "job" has comparatively got harder (i.e. more expensive). With technological, scientific and medical development we can do more, but at an increased price. In my Dad's day you had a heart attack, they put you in a bed, with a pat on the back and some morphine, and you either pushed up daises or went home a week later. It was fairly easy to have one of the highest levels of state funded medicine internationally because the benchmark was not high and relatively cheap to maintain.

Now the question shifts from "What can we do?" to "What can we afford to do?"

2, We have had a mindless metastasis of management within the health sector. Inevitably with any arm of government there is a separation of funding from performance. In such environments all kinds of anomalies, inefficiencies and inequities develop. They develop because of the absence of market forces provide a feedback loop to correct them.

For me personally it’s the blatant politically correct dishonesty of the system that grates most. The public are told the waiting lists are "six months or less". What they are not told is that the waiting time from GP referral to hospital clinic to get on that list, is often over a year long (mine currently is). Many people referred by their GP don't actually ever get seen but are re-referred back to the GP (one of my small victories was to get a system in place, in my department, to at least inform the GP and patient that this had occurred). Once you are finally there you are assessed on a national points system. Many people don't qualify. So they wait to get on the waiting list.

For many, who have been taxed into oblivion, the public sector is sadly the only option they have. However also sadly there are those who may have more options, but lack the information required to make a reasoned decision.

No, you misunderstand.

Ross Elliot's picture

No, you misunderstand.

*All* Kiwis are covered by tax-funded healthcare. That means hospitalisation is "free". You have a heart attack. An ambulance comes. You get treated. You don't get a bill.

Doctors/specialist charges are only subsidised for the elderly & kids. Prescriptions are subsidised for all. Our health system is more like the UK's. Australia's is more like the American system.

As I said:

"The American healthcare system is used by government flunkies as an argument from intimidation. In NZ it is widely regarded that in America only the wealthy get good medical treatment & the poor bleed to death while merciless hospital security guards evict them from the premises."

My understanding is that in the States there is still a strong supply & demand connection between healthcare providers & the consumer, and an attitude that you must provide for yourself. That's *not* the case here. Not by a long shot. As I said, medical insurance is not tax deductible. That's a big clue as to our sad state of affairs.

That's strange...

Pete L's picture

The New Zealand system doesn't really sound much different than the American system - part private, part state. We have programs like Medicare and Medicaid for the young and elderly, as well as state specific programs as well.

So if I understand you correctly, all others besides children and the elderly are responsible for funding their own health care (except for perscription drugs)?

NZ has a high degree of

Ross Elliot's picture

NZ has a high degree of state intervention (read: tax & spend) in the healthcare market. If memory serves, the health budget is about 20% of government expenditure. Funding is from general taxation. GP (MD) consultations are subsidised for young children & the elderly. In my part of the country to visit your GP costs around $45. That's the full, unsubsidised cost. I visit a specialist about once a year and the full cost is $145. Prescription charges are subsidised to a greater or lesser degree and drugs are purchased through a government agency, Pharmac (sp?). This results in a restriction of drugs to the NZ market as the agency tries to "rationalise" costs. Specialists often have trouble prescribing some treatments due to unavailability.

Hospitals operate on the basis of waiting lists and a points system which promotes patients considered more "at risk". Waiting lists are long and to the best of my knowledge suing for malpractice is not fully possible (this may be due to our state-funded accident compensation system; perhaps another Kiwi knows more about that).

Due to these artificialities, service is lacklustre & surly, even in pharmacies, probably due to the fact that pharmacists get the bulk of their income from the state & not the customer. Many NZ medical graduates move overseas for higher wages & better conditions. Subsequently, many doctors and staff from less wealthy countries emigrate to NZ to staff our facilities. The American healthcare system is used by government flunkies as an argument from intimidation. In NZ it is widely regarded that in America only the wealthy get good medical treatment & the poor bleed to death while merciless hospital security guards evict them from the premises. I shit you not.

Dental care is free until a child leaves school.

Despite this "comprehensive" level of state support, Kiwis have a high uptake of private medical insurance. I stand to be corrected but I think that per capita it's somewhere in the top five in the world. Medical insurance is not tax deductible. If it was, the public system would be fucked beyond even private medical help Smiling

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