Posted by: Vallere | April 30, 2011

Friday’s Flipside Five – The Doc Speaks!

Woohoo! My first guest blogger! I’m big time, now, y’all!

Today’s FFF is being turned over to the very capable hands of The Doc, who will give us a little insight into the medical world. He’ll be sharing five comparisons between the US medical system, and the one here in New Zealand. Enjoy!

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While different,  both systems are very capable.   Below is part fact, but also part opinion.   At the end of each of the five differences,  I will choose the winner.  This is the one I like the most, though realistically both have their advantages and disadvantages.  Much of what I am writing about I have experienced first hand, but there are some areas I have only heard second-hand.

1) COSTS

While certain things can still be quite expensive, costs are for some reason better controlled in New Zealand.  There is an expectation by many here that they will not have to pay much for care.  All routine and accident care is subsidized.  Accident care is free if you are taxable and routine medical care is free if you are a citizen, resident, or here with a two year or longer VISA.  I really have no idea how a country the with only between 4 and 5 million people and a tax base of probably between 1-2 million can provide care at all, even less more cheaply.  These prices are affected by significant inflation here, as in the U.S,. and are on the  rise, and the system is thus under stress. This is the case in many countries, and there are concerns  that many of these  costs will begin to trickle down to patients or tax payers.   Here are probably a few of the reasons, though, that this rate of inflation of medical costs has been slowed in New Zealand compared to the U.S.

     1)  Rationing –  While I think there are ways that this could be improved, this is a drastic difference between the two countries.  If you get sick you have less medications to pick from, but still a good number are available, some not even available in the U.S.  You are forced to  pick a cheaper medicine and trial this and other alternatives before moving on to other options.  I think this system is not run as effectively as it could be, as some really expensive medications do not require “special authorization.”  For example, many expensive atypical antipsychotics are available without trialing the cheaper generic brands first.  In some cases there is a restriction in options despite generics that are cheap being available (for example there is no extended release amphetamine and only one amphetamine product on the market).  At the same time, though, you can get permission to ship some of these drugs in at the patient’s cost if you can justify their need.  Overall, medications are rationed by costs significantly more effectively.  Additionally, so are tests such as MRIs and other expensive diagnostic procedures.  These are available if needed but are not in many towns and thus not used often.  Less tests of low yield are often ran in order to rule out the more uncommon or rare possibilities.  This may be due to availability, differences in training, but also a  lesser degree, a less litigious society.  Doctors cannot be sued for insane amounts of money which removes many of the costs associated.  Despite this, they can be reprimanded to a degree by the Ministry of Health and have professional or criminal punishments applied where applicable.  If someone is injured, they end up being cared for by the ACC, much the same as if they got injured in a motor vehicle accident.  In these cases, medical bills are covered and they get some routine income that is quite limited. 

2)  Monopoly – yes you heard it ….the government or any organization can lower costs when they have the lion’s share control of the market.  New Zealand has an entity called Pharmac that makes deals with drug companies about what drugs they will even allow into their country.  If these companies give reasonable prices, then they buy the drugs and allow access to this market.  As such, they get lower prices for many of the same medications.  The drug companies really hate this and you do not see their presence much in this country in the doctor’s offices as  there is no such thing as the a drug closet in each office with the newest and most expensive medications.  Often times it’s the case that many of these medications are no more effective or less so than older ones.  As for drug commercials…..I have not see one on the television yet.  The down side to this is that some drugs are not offered here as it is not thought of as a profitable market.

Winner – New Zealand.

2) PROFESSIONAL  LIFESTYLE

Doctors and other staff are paid less here, but they do get access to other resources  such as more time off.  Six weeks is standard along with 2 weeks of GME.  There also is a significant chunk of allowable annual money for continuing education.  Additionally, the hours here are more in the 40-45 hour a week range, something I am not used to but am liking, and Vallere has noticed I get more family time.  The amount less is not a huge bit for some professions, but for the procedural fields it is significant.  Again, the tax rate is 38% above about $57,000  which eats even further into what you take  home.   From what I have read, the pay is more correlated in this country with the years training.  On the downside, many health professionals leave the country to make more money and to unfortunately avoid paying back their student loans.  I have been told they have to be taxable for the government to get their loans back, but that this may be in the process of being changed.  This may be why New Zealand is forced to recruit health care workers from abroad and I presently work with a very diverse group of physicians.

Right now, I feel I can ethically provide great clinical care as I get adequate time with my patients.  I can spend 90-120 minutes on new evaluations, see therapy patients, spend 45 minutes to even an hour on some follow ups.  It takes longer to do good records here as the paperwork is slightly more.  Despite this, I get more face to face time with clients.  I can even make trips to schools to observe kids or attend meetings there or elsewhere at times.  While one can do this in the U.S., it’s easier to do here and leads to the primary difference in number 5 below. 

Costs of living are quite reasonable overall and there are tons of free things to do with all the natural beauty around.  If you want the big city, though, there are less limitations as only a few exists in New Zealand. 

Draw – This Depends on what your values are.  I personally favor New Zealand at this point in time.  If you really favor the higher salary and the big city, then the US would be your choice for winner as you make less, the taxes sting more, and most locations consist of small cities.

3) ACCESSIBILITY

In New Zealand, the wait may definitely be longer to see a doctor, but such is not always the case.  If you have a doctor, you can get in to see your general physician fairly quickly, but sometimes there can be a shortage of these doctors that are taking on new clients.  Many times you are led to see nurses or other professionals first, but when you do see a doctor, you see a doctor.  Physician extenders do not exists here which has both positive and negatives.  As there are few to no costs associated with seeking health care and being on daily medication treatments, I think the access to care is more equal across the different socioeconomic areas.  Medications that are subsidized cost 1 dollar a month or about 80 US cents, and this is the majority of medicines.  If you get a certain number of scripts a month you can get them for free  by getting a high usage card.  Private clinics and hospitals do exists and allow you to get uncovered services, or be seen faster if you desire, and private insurance is available here for hundreds a month (yes you can gasp as in the US it cost our family of five $1700-$1800 dollars a month on the private market).  Some surgeries that are elective can have long waits, a year or more I hear – though have not witnessed such.  Again you could probably get these faster if you carried a private policy

Winner –  New Zealand due to universal coverage.  This likely removes some of the financial barriers to treatment and may also reduce tertiary treatment needs in future years, though I cannot show the numbers to support such a claim.

4)  CHOICE

This is an area that is often a weakness I hear in similar systems.  In the US, you can get access to a specialist or sub specialist faster and there are more options available for treatment  and placement, though many are not necessarily options to those that cannot afford them.   In the US, if you are not happy with your care you can easily move on to another facility, doctor, therapist, social worker etc.  You can ask to do the same here but there are limitations and you often have to stay in the same office unless you move or find someone in the private sector.  Even if you do, many general doctors and clinics are full and there are less options. 

Winner  – U.S. hands down

5)  COMMUNICATION

Communication between doctors and other health professions is better in New Zealand from my limited experience.  I send a summary letters for most appointments to general and consulting doctors.  The only exception is that when I am seeing someone weekly I will often combine letters and only send them out every couple of weeks.  I am in a weekly committee with others from different systems such as the educational system, and early intervention, private organizations, and pediatricians (specialist here)  and discuss the more difficult cases (with consent of course).  I honestly have never seen anything like this in my 6 years of training in the U.S. though I am sure it exists in some places.   I think this allows for better quality care in many instances as you are not constantly “reinventing the wheel.”   It also allows for better relationships between organizations and systems.   I think this is limited more in the U.S. due to time restraints on physicians.  You need time in your day to do this and that is difficult to make due to strains on time and the need to turn profit.  Obviously, attending an hour meeting 3-5 times weekly would likely bring in zero money in the States unless you were contracted for this time. 

Winner – New Zealand

As far as quality of care – this is something I could write about for hours on both sides.  I think it’s a bit dangerous to put this online though as it would be even more opinion based than that above.  I would not want to waste your time here without more facts and evidence.   Even though New Zealand won 3 out of 5 of the categories above, I would not venture to say the system here is superior,  but it is quite different and one that has been a refreshing change thus far for me and my family.

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Well, there you have it, folks! Tune in next time 🙂

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Responses

  1. Thanks for doing this Doc! It was nice to hear your honest thoughts and feelings as a doctor 🙂 . It’s so nice that you are not quick to jump and say NZ is the best or the US is the best. Different is different! I’d love to hear you blog again maybe about how the schools deal with children who need your services. Keep up the good work!!!

  2. Oh wow, this was so interesting to read! I love your Friday posts! 🙂


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