People have been asking me what is health care like in New Zealand so I will attempt to provide my initial impressions formed over the past three months. While there are multiple factors that apply to health care, I find New Zealand's system more fair and makes far more sense than what we have in the states. Here it is more about providing care to people than it is about running a business and there is not this titanic political battle over how to go about providing it like in the US.
Medical care in New Zealand is provided by a relatively extensive system of public hospitals that treat citizens or permanent residents, including visa holders like ourselves, free of charge. The care is managed by district health boards which run the hospitals with all of the funding coming from the government. I work for the Taranaki District Health Board and staff the ED at Taranaki Base Hospital in New Plymouth and occasionally cover shifts at a smaller Satellite hospital in Hawera in south Taranaki. Around 75% of all health care expenditures here come from the government with the remainder provided by a secondary market of health insurance organizations that fund treatment and operations for their members privately and I believe that they even have their own private hospitals.
When you show up at a hospital due to illness or injury there is no attempt to get your co-pay or your insurance card. There is no worry that this hospital or doctor will not take your insurance and you will be saddled with an exorbitant bill. You show up, get treated get admitted or go home and there will never be a bill.
The DHBs also are mandated to focus on the overall health of their communities through Primary Health Organizations which provide a general practitioner (GP) for all New Zealanders. These are strictly non profit and I believe there are incentives for people to sign up for them. There is some cost to see the GP but your income status is accounted for and if you are referred to a specialist of any kind there is no payment. I believe that more effort is spent here on health and prevention of disease than on treatment. New Zealand spends about 25% of what the US does on health care per capita, Kiwis take the lowest amount of medications of any developed nation, and the life expectancy is 81 years compared to 78 in the US (all figures from the World Health Org website).
Health care expenditure is less here not only because people are healthier but care is provided in a more rational way. Fear of malpractice and defensive medicine in the US without a doubt increases the amount of expensive and frequently unnecessary testing that we do. New Zealand is one of the only countries in the world where you are unable to sue someone including doctors and hospitals for personal injury or what they refer to as medical misadventure. This is all covered under a government entity known as the Accident Compensation Corporation which is the sole provider of insurance for all accidents that occur in NZ to citizens and visitors alike. It is administered on a no fault basis and coverage is provided regardless of the circumstances, paying for the costs of treatment, recovery and lost wages. People who have suffered a personal injury do not have the right to sue except for what is termed as exemplary damages. If you live alone and are injured the ACC will even provide someone to help with household chores until you are able. I get the feeling that some abuse the ACC and come seeking time off and services that they don't need but for the most part it seems to be used appropriately.
Back to my point though, without the threat of an attorney waiting outside your hospital for you to show up so they can serve you a malpractice summons, medicine seems to be practiced in a more sensible way. For instance if I call the radiologist in the middle of the night to do a CT scan of an old drunk who fell down and hit their head and aren't acting quite right, their argument will be "you do not need the CT scan now because even if there is a head bleed you are not going to be doing anything about it until the morning anyway". While they would get the scan for sure in the states, and 95% of the time they would be normal, here we watch them until the morning and most likely they will wake up and be fine. Anyone over 50 in a US ED with abdominal pain most of the times doesn't go home without a CT scan. Here I call a surgical registrar, the equivalent of a resident, and they usually observe the patient and maybe get a CT scan later if warranted. There is no "pan scanning" (full body CT) trauma patients, only focused studies on where injuries are likely. I haven't seen many missed injuries yet. Here I very rarely admit someone having chest pain unless there are signs of ischemia on an EKG or an elevated troponin. They usually get a second troponin 6 hours later and then I order an out patient stress test will get done the next day and reported to a cardiologist and their GP.
I believe that part of the problem in the states is all of the people making money in health care who have absolutely nothing to do with providing it. All the millions that go to insurance companies and their handsomely paid executives, all the lawyers and expense of litigation in our system, all the billing people that hospitals and doctors have to hire. Too many people in the middle preventing the delivery of appropriate and cost effective health care. The way health care is run here may be sustainable due to a by and large more healthy responsible and much smaller population than in the US. I wonder though if in the future New Zealand will be forced into a more private model of health care as in the states. These days it seems as if every country with the exception of China owes a ton of money and many including NZ may be forced to make less financial promises to its people.
Increased efficiency comes with all the public hospitals being able to access patient records no matter where they have been previously. This saves on repeat workups on chronic conditions that patients present to different hospitals with.
While it is true that in a socialized medicine framework care is rationed to a certain extent and people will have to wait for certain elective procedures but no body will go bankrupt because they became ill or injured. Those with the means to do it can buy separate insurance so if they need a non emergent procedure like joint replacement, gall bladder removal, or knee arthroscopy they can get it more immediately.
I don't pretend to know what the answers are for health care, but I very much enjoy working in a system where good people without health insurance don't ask me how much a test or hospital admission is going to cost them. I am realistic and realize though that in the future this system is likely not going to be sustainable. As in the states there is an aging baby boomer population that is going to put more stress on the economy and it seems as if countries that do provide health coverage for all are in financial uncertainty. I also get the sense that the legal landscape will change here at some point into one that is more litigation friendly.
As far as the work goes I enjoy the ED at Taranaki. We serve a district of about 100,000 people and see about 35,000 annually in the ED, about 90-100 a day. As boarded in emergency medicine I am considered a consultant and there is single coverage consultant level care in the ED 24 hours a day. There are also several house officers, the equivalent of interns though with better training than typical US interns. Medical school in NZ is typically 6 years followed by an indeterminate time as a house officer, sometimes for many years before they decide on a specialty track. They sign on to work in the ED for 6 to 12 month stretches and are quite functional and helpful. There are registrars (residents) and house officers that cover medicine, surgery, orthopedics, ob-gyn, and pediatrics. I usually consult the appropriate service early in the patients ED course and they take the patient over if admission is needed. There is also a crisis team that will come to the ED and manage any psychiatric, or suicidal patients and they don't require a whole slew of medical tests for me to prove to them that the patient is medically stable. The hospital does have a fairly wide range of services that it provides. Neurosurgical cases usually get transferred to Wellington, cardiothoracic surgery or interventional cardiology go to Hamilton, and spinal cord injuries to a center in Christchurch. There is also somewhere where major burns go as well but I don't remember where.
We do have a trauma team but it does not get activated much. No shootings, most real trauma has to do with logging, farming or oil and gas industry. EMS does not board and collar everyone in an MVA, they are actually allowed to use some clinical judgement.
Nursing staff is excellent and hard working. I work with people from Scotland, England, Ireland, South Africa, Zimbabwe, Canada and the US as well as New Zealand. The kiwi lifestyle is one that places a high value on time away from work. I work on average 3 and a half 8 hour shifts per week for my salary but will usually work a few extra shifts here and there. I also get 6 weeks paid vacation, which seems to be pretty standard, as well as 14 days of paid CME (conference time) which is nice. I am able to spend far more time with Jenny and the kids than I ever have before which I think is great (they may disagree). We are leaving for a 2 week road trip through the South Island tomorrow which will be the longest vacation I have had since medical school. People from other countries can't understand why we work so hard in the states and they think it criminal that I didn't previously have paid holidays.
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| Aloha from Oakura |
Jenny ran the New Plymouth half marathon 2 weeks ago. She had been doing fairly rigorous training runs with a local running club and she finished in 1:58 which was a personal best. The fact that the entire course is either up or down hill and that it was pouring rain at the beginning make it all the more impressive. Good on ya Jenny as the Kiwis say.
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