26.8.10

Remember health care reform?

Access to health care is a human right. A long-held dream of Democrats has been to have universal health care coverage in the U.S. Americans whose jobs come with health coverage will see little effect from the health reform legislation that was passed in March. But it will do a lot to help the less fortunate and control costs.

In New Zealand, the health sector is predominantly State-owned and operated. There is universal coverage for New Zealand’s residents. In the last three decades, health insurance elements also have been introduced, creating a mixed public-private system for delivering health care.

Nobody in New Zealand needs to worry about being able to afford health care. But reigning in health care costs is a concern. There aren’t enough resources in our small, remote country to meet our demands for treatment. (A lack of resources is not likely to be a problem in the U.S.) Of course, people want to get the best care that they can, and everyone should have equal entitlement to whatever services are provided. But we still need to figure out how to ration who gets treated according to need and ability to benefit.

For years, there has been an ad-hoc system of rationing care in New Zealand. We sometimes joke that we need to “be our own advocates” when seeking care, or we complain about "lists". But care should not go to whoever complains the loudest. This is a downside of our politicized public health system.

We also need to stop the escalating demand for health services by better addressing societal problems like alcoholism and obesity. I think public health money would be well spent insulating our houses.

Our health care professionals need more incentives to be cost-efficient and deliver treatments better in their regions. If the public sees health professionals leading the way for change, people may be more likely to get behind their initiatives.

7 comments:

Secret Mom Thoughts said...

We have private health care. The new plan is getting rid of our Flexible Spending Accounts (in the US). It is all our money but it is put aside to cover expenses not covered by insurance. It has really helped us budget for dental and eye care that is not covered. The new plan is not helping me. I have family in the UK and their government health care system is scary. They have to wait so long to get medical tests and even surgeries. I know the plan with help those without insurance but it seems to be making it worse for those of us with jobs and coverage.

Juli Ryan said...

Thanks for your comment. I guess I don't understand why you still can't put aside money for things that aren't covered by your insurance (even if it is after-tax). To me, sacrificing your small pre-tax savings would be worth giving everyone access to care. And in the long run, I think you will see that it works out much better and cheaper for everyone if health insurance is regulated.

I know a lot of people from the UK, and I have not heard horror stories about their NHS. Quite the opposite. But you're right, it's a matter of accepting unpleasant truths, like a 92-year-old woman will not have the same benefits as a 10-year-old from a knee surgery, and the 92-year-old may have to wait longer to get the surgery. Or that sometimes it might be more appropriate to see a nurse than a GP. Or that bigger hospitals are more efficient.

Even in a very small country with universal care, I have not had to wait for care that I need. I can see my GP on the same day and have found the quality of care that I have received to be very good. I probably should have mentioned these things in my post.

JoeinVegas said...

Care is semi-rationed here. The national plans (Medicare/Medicaide) keep lowering their payments, so fewer doctors will accept those plans. If you have private insurance (like I do at work) you are limited on where you can go, and have to be approved for things ahead of time. I just started a new job, and the new health plan will not pay for some of the medicines I've been taking for a long time, so it's off to my doctor (I have to pay extra to keep going to my regular 'out of plan' doctor) to figure out what I can take. (sorry, way to expensive on my own). Other things are limited, we want a single payor plan but Congress is afraid of not getting reelected so they always push real reform off.

Juli Ryan said...

Joe, thanks for your comment. I think some of those problems will go away when health care is not a for-profit business that lines the pockets of the executives at insurance companies. I do think the health bill could have and should have been more. But it's a start, and Americans should be proud of it.

In my region of NZ, I also am limited in where I can go and who I can see. This is because there is a shortage of health services in my area. So, I can't just say, I want to see a specialist, or I want a second opinion. But if my doctor says I need a medicine, it is covered. And people do have the option of "paying extra" to get red carpet treatment. Ironically, if you have private insurance, you see the same doctors. It just might be in a prettier environment.

lavenderbongo said...

The health care service in the UK is a great idea in theory but not in practice. I love the fact that we never had to worry about having to pay for anything but hated the fact that you were never guaranteed to get all medicines that you needed and you had to wait sometimes for years to see a specialist. The NHS is overused and underfunded. It came as such a shock when we first went to the GP in NZ. They were happy to have a chat and we were given a full examination before being given a diagnosis. In the UK it felt like you were in a factory production line. You were in and out as quick as possible - the same when giving birth, in and out in a couple of hours. I could also list some appalling experiences that my grandparents have been through in the NHS. As you can tell this is something I feel quite strongly about. I love the idea of the NHS but not the reality.

Arthur (AmeriNZ) said...

I had private health insurance for years but recently let it lapse because I realised, finally, that I don't actually need it.

I think the important thing to remember about the NZ system is that it's universal, which the US system still isn't. All citizens and permanent residents are fully covered (people on work visas are covered less).

The ad hoc rationing you mentioned is something the two major parties both want to address, and it is a complex issue. But everyone is treated eventually and—most important of all—they leave hospital with no bill, no debt, no financial worry. No one in New Zealand will be bankrupted by healthcare.

Whenever this subject comes up, people invariably trot out individual cases to "prove" universal healthcare is wrong, but anecdotes are just that. In New Zealand, universal healthcare actually works quite well, and having it means we don't have an economic brake on this country like the US does, and that means our per capita healthcare spending is much less that the US for similar outcomes.

Practically Perfect... said...

As someone who works right in the midst of healthcare, this is really interesting to me. I'm still fairly new to the country and am learning about the system, but it's interesting to hear more about it and to see different points of view. I enjoyed reading the comments!