[migratory birds]

Interested in hearing opinions on how the NZ gov't supported healthcare system compares to the private pay system in the US. Particularily in how you see that it serves the whole of the population.

I know that many Americans who emigrate had amazing individual or group health insurance coverage can be less happy with the NZ system. But many adults and children in the US are without any health/dental insurance.

I'm more interested in hearing how the overall gov't supported system serves the whole of the population.

Also interested in hearing how the NZ system compares to care systems in other commonwealth countries.

[Park City Partner]

As an American living in NZ I am impressed with the medical system here. I had my baby here a year ago and am so glad I delivered here vs. the States. The care was fantastic, particularly the after care and far superior to what I would have experienced in the States. Granted there are some issues with the system such as waiting lists etc. and the drugs available are much more limited. But overall I think it is pretty good especially for the majority of the population, unlike the States. When I was in the US I paid about $400 US for health insurance (I owned my own small biz so wasn't part of a company plan) and it was only adequate, still had a large deductible (excess) and wasn't 100% coverage. Now, we pay $125 for private insurance as a supplement for a family of 3.

I might have a different opinion if I get really sick but for now I am very pleased.

[wanderingoregonian]

So far I've only had routine care here. The 800 health line was helpful too the one night my OH was sick and we didn't know whether to go to the ER or not.

So far so good

- I was able to make an appointment with only a week lead time (always waited forever in the states), no paperwork hasseles at the dr office (I've had some negative experiences in the states where I had call my insurance company to change doctors - mine had changed practices - from the reception phone; no big deal unless you are seeing the doctor because you're really ill and can barely stand, let alone be on hold with your insurance company)

- doctor gave me plenty of time to discuss things. In the state I found the insurance system intruisive in that my doctor had to constantly worry about what to bill for the time.. which ICD-9 code etc. It was better to been seen twice for two small ailments, than one longer appointment etc.

- everyone has coverage of some sort... and all accidents covered by ACC. I was one of those with great coverage and then as part of the move learned that my health history precludes me from getting private insurance in the US.

It is very freeing not to have health insurance/coverage linked to full time employment. If I want to work 3 part time jobs, fine. If I want to take 3 months off to travel, fine. If I want to work 2 jobs I love, both part time, that's fine too. If I want cut back my hours to spend time with kids, fine. I think it is better to have the work force choosing jobs based on things like salary, hours, flex time, quality of work, work enjoyment, etc. I never realized how often I heard people talk about career/work choices back home in terms of maintaining health insurance (as in "I can't quit my job because I need the insurance") until I no longer heard it. I completely understand not being able to leave a bad job because you need the money or experience, I have a hard time vouching for a system that makes people do that for somethign like health insurance. We're just used to health insurance being a job perk in America, but I imagine that it could be as foreign to non-americans as having car insurance be an employment perk (and one that is hard to get through other sources).

Just my 2 cents... yes I think that if you have a chronic illness, you're probably better off in America (assuming that somone has full time work and great insurance). But here I think most people are better off. We'll see what happens in the years to come. There have been some things in the papers that have worried me. I think NZ will have problems if they adopt too much of a managed care mode. A single payer system is great, but not if you make reimbursement too complicated or its underfunded.

[JoHnH]

Kiwi perspective with examples:
Back in say the 1950s, the State health system was I think pretty comprehensive. For example, my father had a serious motor accident requiring a hospital stay and follow-up treatment. There was no question of anyone paying for anything.
The bare bones of the system remain, certainly in respect of emergencies - I recently had a minor stroke, involving a hospital stay, and received the best of treatment, I had to beg the doctors to let me go home. No question of payment, except a voluntary donation to the Ambulance service. Same for my elderly father-in-law on several occasions.
On the other hand, there is the problem of waiting lists for elective or non-urgent treatment, caused I guess by the growing cost of health-care and limited tax dollars available. Last year my wife developed a gall-stone situation, painful but not immediately life-threatening. Since we look quite wealthy (we ain't) our GP automatically arranged (excellent) private treatment, cost about $7500, got about $6000 back on our el cheapo health insurance scheme. An American nurse at the clinic reckoned the same state-of-the-art pinhole surgery would have cost three times as much in the States, mainly because of the surgeon's malpractice insurance - none of that here, of course, because of the ACC scheme.
Cost of kids care was never much of an issue when ours were growing up, vists to the GP were heavily subsidised and charges therefore nominal. I believe it's still much the same now.
You pay through the nose for dental treatment, however. One solution which worked for me for a while was to marry a dentist's daughter.

[swissmissdesigner]

I hope that you all get a chance to see Michael Moor new movie about US Healthsystem.
It is amazing movie!

[movefromus]

My parents (who live in NZ) lived in UK for a few years - 2001 til 2005. I think I could safely say that they like the NZ healthcare system better. The UK one drove my Mum a bit batty at times I think. The system of referrals there was a pain and if she wanted to see the Dr. about multiple issues they'd make her make multiple appointments. She also wasn't very free when it came to choosing her Dr.

We have pretty good health insurance in the US and have not had any problems with waiting for appointments or tests of any sort. Maybe other areas of the country are different - I don't know.

Carly

Just thought I'd add that even when we had no insurance we didn't have to wait but it did cost a lot.

[Rabbit]

The UK public system is crap - everything is universally free so the system gets clogged up with allsorts, with free treatment for hypochondriacs, those looking for a sick note, and other minor ailments – these things detract from primary care.

In the NZ, I have found the service more responsive, but at the end of the day you pay, so no different to private practice in the UK.

Basically, expect to pay to go and see a GP, and also expect to pay for tests.

If you need to see a specialist, then expect the queues to be slightly shorter than the UK NHS.

The average GP patient consultation in the NHS public system is about 7 mins and in NZ probably nearer 15 mins so a better service, one which you will pay for.

I am happy to pay for it.

If I had a heart attack, kidney stone or breast cancer, then at the moment I would prefer to have such an event in NZ rather than the UK, in that I would feel that the care I will recieve would be more responsive.

I still have the feeling that if I had an accident in the US, they would resusitate me, check my wallet and then decide on how to proceed.


Rabbit.


IMHO

[migratory birds]

"Basically, expect to pay to go and see a GP, and also expect to pay for tests."

How much do you pay for an annual exam visit and basic labs? A twenty minute visit with a paediatrician for a cough 7 yrs ago would have cost $90 USD if we hadn't had insurance. $270/hour for someone to tell me my kid had a respiratory infection and there was nothing to be done. Basic annual exam type labs (CBC, chem screen, liver enzymes, chol panel) here would cost hundreds of dollars - likely over $700 if one had to pay out of pocket for them.

"I still have the feeling that if I had an accident in the US, they would resusitate me, check my wallet and then decide on how to proceed."

You're right on that account. Check your wallet to see what kind of insurance coverage you have before proceding. It drives lab, imaging, medication and surgical decisions. I imagine Michael Moore's movie "Sicko" (producer of "Bowling for Columbine" and "Farhenheit 9/11"), looking at the American healthcare system, opening this month in theatres across the US will eventually make it to NZ in some form, he interviews a fellow who loses 2 fingers in an accident and his insurance will pay to have only one reattached and he needs to decide which one it'll be.

[toesonthenose]

When we compare medical systems we need to take into account the 47 Million Americans without health insurance. The World Health Organization ranks the US at about 38th in overall health. Considering we spend double per capita what any other nation does, I would rate the US system as inefficient and wasteful. I work in healthcare as a physician, and the US system is more dedicated toward preserving obscene profits for insurers and pharmaceuticals than actually caring for the people. While my income has been flat for 12 years, the drug representatives whom I know are driving Porsches, Mercedes, and taking company paid education trips to Paris....from Hawaii! Healthcare is complex, emotional, and more art than science, and requires a fair and comprehensive financing system. The American idea of the "market" running healthcare has lead to greed, disease, and death. We see the same Enron type abuses in healthcare with the likes of Healthsouth, Coumbia/HCA, Blue Cross/Blue Shield, Merck, Warner/Lambert, etc. Healthcare is to important to be just another source of funds to steal by our culture of corporate corruption. Our idolatry of "profit" and the divine hand of the "market" will continue to contribute to our national ills.
Mahalo for listening, Shaun

[dharder]

The UK public system is crap -

I have not found that to be true at all for us, and actually, for hardly anyone I know personally.

There are definitely areas that are problematic, but on the whole, I am more than happy with it.

I always get a same day/next day appt with my GP, my NHS dentist charges very reasonable prices (free during certain times of your life). When there really was worry that something was wrong during my second pregnancy, they moved with speed and efficiency.

Considering it is free, no one is left without insurance, and my children don't pay anything at all (prescriptions and dentist), I have nothing to complain about.

Daniela

[clg]

I far prefer the NZ system, we had excellent coverage in the US so we got good care but it was expensive and there was always the threat of losing/changing jobs and the impact it would have. As noted above, GP's spend more time with you here and I feel much less like on an assembly line. We had babies in the US and NZ and would say it was MUCH better in NZ. As to wait lists, you can buy insurance (around 20-30 per person per month) that will let you go private if you need to.

I just had a situation where I quit a job, moved to a new job then quickly realised I made a mistake and went back to my old employer. This would have been a nightmare in the US, at a minimum we would have had to pay for extra insurance, worst case is I could not have quit the new job I hated for a while because I would not have been covered under insurance.

One US healthcare thing I do miss though is our dental insurance, that seemed to work quite well.

Chris

[Rabbit]

I have not found that to be true at all for us, and actually, for hardly anyone I know personally.

Daniela

In the UK, we used to wait 5 to 7 days to get an appointment. Then the government started getting complaints about waiting times, so the rule was changed so that you would only be allowed to ask for an appointment twenty four hours before e.g. not allowed to make an appointment more than 24 hours in advance. Just so they could say they are treating patients faster. Not very convenient if you have a busy schedule.

Sometimes the waiting lists are just too long in the UK, e.g. three to six months to see a specialist. Often people get fed up with waiting and end up going private.

Because it is mainly all free in the UK National Health Service, demand exceeds supply capability.

In NZ the GP sends people for a good range of tests straight away and then decides if you need to see a specialist.

All the results from the lab are emailed back to the NZ doctor, so it happens very quickly. I have also found NZ Doctors to be allot more open with their patients.

In the UK the GP normally does very few tests, sends you to a specialist, you wait three to six months and then they do some more tests.

I find the NZ system most efficient and responsive compared to the UK, yes there are alot more costs in NZ, but a much better service.

IMHO

[incredible hulse]

My own thought
- The GP system in NZ is pretty good compared to the UK but as mentioned you pay for it - I would be happy to pay for it in the UK if I could see a doctor same day.
- Waiting lists in NZ are just as bad for hospital visits as UK from our experience (maybe worse) - we have been waiting 8 month to see a paediatrician ! The other thing to take into account when comparing NZ to the UK system (not crap IMHO btw) is the range of drugs that are not paid for by Pharmac that are readily available under the NHS - we have encountered this for our son in that he would benefit from some drugs that he was on in the UK but would cost us 13k+ if we want to continue here (this is a cost cutting measure by Pharmac).
- Maternity care very good here compared to UK (dedicated midwife giving "personal" touch). Post natal not so great
- Special needs provision very slow and underfunded in NZ compared to UK

[ElizabethD]

I had an excellent health care plan in the US--but my employer paid $950 per month (as part of my package) to cover our family of four. even with that, my co pays and share of procedures ended up costing us anywhere from 3-5 thousand per year. (hubby had surgery). I did feel very confident in the quality of care but we obviously paid dearly for it and it kept me in a job I hated.

Moving here we have been a little disappointed because like the US, when you have to pay 50-60 dollars for an office visit, you sometimes delay going. We have Southern Cross and pay $137 per month for our family but that only covers specialists and there are limitations. The most disturbing thing with Southern Cross is that preexisting conditions are not covered EVER.. that was shocking. :mad: I would never consider not having insurance in NZ--it is an absolute must have.

My hubby has been referred to a urologist for an ailment and the referral came through quickly. The doctor of course asked if we had insurance. When we said yes it seemed that doors opened up.

Just some observations.

[DB]

The most disturbing thing with Southern Cross is that preexisting conditions are not covered EVER.. that was shocking. :mad: I would never consider not having insurance in NZ--it is an absolute must have.

You need to remember that the insurance based services in the USA and NZ serve vastly different purposes. In the US your insurance paid for health services covers you for everything, as, frankly, there is nothing else. Therefore, they have to cover pre-existings, as otherwise virtually no-one could have health care.

Those big USA full service hospitals are thus funded by the payments the insurance industry makes to treat patients. They are the only hospitals.

In NZ, the private health industry exists (as it does in the UK) to provide consultants with an additional source of income beyond which they earn in the public sector. The majority of that work is paid for by insurance companies, and insurance companies dont really want to pay claims, so a pre-existing condition is almost a guarantee they'll need to pay out, so they will avoid taking on that risk. Same way they dont insure young drivers in stupid cars.

The private hospital facilities in NZ are geared around this sort of work, the general surgery que-jumpers. The private hospitals are not full service hospitals, although in the areas in which they specialise they will be very well equipped.

Trauma care is one specific example; if you have a damaging accident, your insurance cover wont help you, as you'll be carted off to the nearest suitable hospital, and they wont ask you about your insurance cover.

...if we had insurance. When we said yes it seemed that doors opened up.

Yep, for non-urgent work, that is indeed the case. But remember, as pointed out by another poster above, you are going into the second tier health service. If it all goes wrong and the private hospital gets out of its depth, or it looks like you'll be stuck there for a long time, then the private hospital will just dump you, and you'll get shipped off to the local public hospital.

In summary, having health insurance in NZ is very different to having health insurance in the USA. Its not a bad thing to have, but you need to look at it from first principles, rather than assuming it works just like in the USA.

[wanderingoregonian]

Originally Posted by ElizabethD
The most disturbing thing with Southern Cross is that preexisting conditions are not covered EVER.. that was shocking. I would never consider not having insurance in NZ--it is an absolute must have.

You need to remember that the insurance based services in the USA and NZ serve vastly different purposes. In the US your insurance paid for health services covers you for everything, as, frankly, there is nothing else. Therefore, they have to cover pre-existings, as otherwise virtually no-one could have health care.


- regarding pre-existing conditions, in the states my fairly minor pre-existing condition meant I couldn't get individual insurance. Only option was to get empolyeed and go through the group coverage model. I was told by the customer service person at the insurance company that even a sprained ankle is a pre-existing condition that would prevent you getting individual coverage until you had a note from a doctor saying it had resolved! I tried to apply for a plan that would cover everything except things related to my pre-existing condition - not an option I was told.

As I understand it pre-existing conditions are primarily covered by group health plans - not because if they didn't all of our other ailments wouldn't be ocvered - but because companies and their HR departments negotiate contracts with the insurance companies directly. I suspect that why school staff often have such good insurance plans may be that school unions are part of these discussions.

Again all this is from an individual point of view... if you get insurance from work its a very different story. This is why you hear of American's who hate their job but stick with it becasue of health coverage - even if I was rich, I couldn't get insurance with out an employer. An if I was rich, I certain wouldn't want to risk all my assets by being uninsured! meeting someone who lost their house when their premature baby's medical bills weren't covered by their COBRA plan nailed that one home for me....

[swissmissdesigner]

I have PPO with Blue Shield and I am very satisfied, everything is always paid 100% on the time. I had a knee surgery in December and recently also had a vein removed from around my right ankle. I choose the hospitals and doctor myself and I was always very satisfied. However I am a PPO patient with all benefits and rights.
I saw the movie Sicko and I am very shocked and feel very sorry for people who have HMO and cannot afford good health care.
I just cried when I saw the move and I wish I could do something about it other than signing a petition for free universal healthcare in California.
We all deserved to have it!

[Super_BQ]

Healthcare is to important to be just another source of funds to steal by our culture of corporate corruption. Our idolatry of "profit" and the divine hand of the "market" will continue to contribute to our national ills.

The US Healthcare system is not even comparable to the socialist countries where the gov't funds their medical care. Has anyone questioned where the new drugs and technologies come from? In the US the big phamaceutical companies work hand in hand with the hospitals too. Their profits go into R&D to produce new drugs and equipment. In comparison, socialist countries rely on gov't hand outs like scholarships to universities. You have 1 hand where it's the gov't role to collect taxes and fund medical care while in the US hand, you have the free market capitalist system (profits) that drive to make new cures.

Perhaps one should ask, what other country produces more breakthrough cures and latest state of the art equipment than the US?

IMO, I see the vast socialist countries lining up to these US pharmaceutical companies and paying the high price. A recent example was in NZ where this breast cancer drug from the US had good results in curing illed patients. Because of the high price, the NZ gov't simply couldn't afford it despite FDA approval (of course the NZ health board didn't recognise the FDA - another case where NZ's 4 million people has better say than US's 300 million population at stake).

When you talk medical care, you must also talk about income taxation. We need to compare on average, how much a person in the US really pays (income tax + medical insurance) compared to a person in the socialised country (which has taxes up to 50% or more of the annual income?

I grew up in Canada and despite the past decade of bad news with Canada's health care system, I still believe it's far better than NZ's healthcare. Patients don't pay for doctor's visits - it's all inclusive care. Upon visiting my home town of only 80,000 population, I was amazed the hospital just brought in a new MRI machine. Of course the BC gov't did not fully fund the new MRI machine but rather, matched the donations that the public provided.

A feat like this can not easily be done in NZ. Just look how many comparable towns in NZ would have access to such equipment at their hospitals? I would be interested to know if NZ has a PET machine? The level of fundraising in NZ is also limited due to NZ's gifting tax. A person or corporate only has up to $27,000 a year to gift (ie. for charity) without paying taxes to IRD. In fact, a generous company could be paying 25% of for every $1 they gift on amounts over $75,000. So when it comes to fund raising multi-million machines, there's really not much $ that can be raised from the public.

Then there's the ACC issue. In Canada, medical "Care Card" is free for those on the low income bracket. But surprisingly, the annual fee maxes out at around $365 a year regardless how high income you make. This is not true with NZ's ACC, for a person over $100,000 annual income, they could be assessed over $8,000 in annual ACC fees. That's a lot of $ to pay just for ACC medical coverage - also the fact that under ACC you've lost the right to sue for compensation as ACC will cover at most 80% of current pay. That doesn't do much in a case where you're put in a wheel chair from a car accident by a drunk driver. I know a friend back in Canada that sued and with the million he won in court, he was able to buy the state of the art wheel chair module for his truck and motorbike which allowed him to drive like a normal person could in his vehicles. But we all agree that $ alone will never get him walking again, however, i'll have to agree that the extra $ does help, by giving him the ability to drive his truck or motorbike alone. I don't think this would be the case under ACC as gadjets like these are extremely costly.

[kanatakiwi]

So many excellent posts here, I am going to print this thread off and read it all very carefully. :nice1

I can't pretend to be an expert here, and there are things that still surprise me and sometimes shock me about the NZ medcial system but overall I think its a good system. As others note, its a system built by successive governemnts, both left and right, who believe that health care is a basic right not a privilege. that's also pretty much true in Canada, but not, unfortunately, in the US.

I joined the local health clinic in my neighbourhood (free), and because of that I pay only $10 per doctors visit, and $3 to get my prescriptions filled. (In Canada I never ever paid for a doctors visit, but I paid through the nose for my prescriptions, and got a certain percentage of that back because I had an employer funded "extended care package") AT this clinic blood tests, pap tests, mammograms, are all free here, as they were in Canada.

The GP at my clinic cannot precribe the same dosages of certain medicines that I was on in Canada without me seeing a cardiologist here. (That would cost $200 approx here and was free in Canada and the wait times are about the same...a few months) As it turns out, I was being over-prescribed in Canada and am doing quite nicely on the lesser dosage, which is a bit of a slap for Canada as they were VERY expensive drugs and cost me a small fortune each month!

I don't have insurance here, am considering getting it, if I can figure out the advantages. My friend who has it says it gets you into the private hospitals when required, but another kiwi friend who refuses to get insurance and was prepared to wait in line to get hip replacement, found that the extra govt funding to clear backlogs for this procedure meant it was done in a private hospital anyway at govt expense with very little wait time. I like that the government is responsive to issues like that. I also hear that in the event of serious injury or trauma, the NZ system performs extremely well.

Being married into a Maori family has also shown me that the health care system is very responsive to cultural needs as well. Hospitals have family rooms, since in a medical crisis it seems that Maori and Pacific Islaqnd families move right into the hospital to have an around the clock watch on their family member. There are Maori midwives who join the OB/GYN at childbirth , etc. etc. Protocol is followed. I like that

Overall I would say, not a perfect system but a good one. I think you will will find it meets your needs as well as your private insurance in the US, whether or not you pruchase insurance here.
G

[wanderingoregonian]

Just a quick comment in reference to being able to sue for things like wheelchairs etc... I consistently am impressed when I meet ACC claimants through my work. Now I know nothing about how fair/good the system is in terms of who gets to be a claimant. But I've met several individuals who've been in car accidents - I've been very impressed with their motorized wheelchairs, augmentative communication systems, wheelchair ramps, home modifications etc. I frequently mutter - wow wouldn't see that in America - when it comes to social rehabilitation. Now I do sometimes see unaddressed needs and am well aware that it isn't a perfect system, but I don't think rehab is best done in a sue/litigation manner. You need a team of people to sort through all the various needs, and a lump sum of money doesn't necessarily buy you quality therapy and equipment. Plus with a system like ACC qualified therapist and specialist can develop their skills within a known system, rather than waiting for peopel to contact them when their settlement arrives and contract with individual therapist/engineers etc. I know for me, I would be way more concerned with receiving quality therapy and equipment should I become severely injured rather than maintaining my salary. The ability to communicate and access a computer are much higher on my list of priorities, than just having a salary. Those abilities allow you to work and live, money doesn't guarantee either.

I also don't mind a bit of a doctor fee... particularly since fees are reduced for children and elderly. I can't say for sure, but I think if everyone could just walk up and get seen, there woudl be longer waits for dr appointments. I called today for an appointment, and was offer 3 slots this pm. I still haven't adjusted to the idea that they book for this week, versus in the states I often waited 1-3 weeks to be seen. Even when I was sick or hurt, it was 2-4 days for an appointment!