Mark's Medical Musings

OK, my turn again. I have been musing on the NZ healthcare system. I expected to find a nationalized healthcare system with a central payer that provided basic healthcare for everyone. The reality is somewhat short of that here. Indeed everyone has subsidized care- they only pay approx $10-35 for a simple office visit (depending on their income level) and kids get free care up to age 5. Most drugs are pretty well subsidized and if you are low income the copays are only $3 per month per drug. Of course the drug list (formulary) is pretty restricted, more so than even our formulary at Group Health. So far so good. Where the system falls down is in the supply of primary care docs, and in getting publicly sponsored specialty care. In the rural areas there are very few NZ trained primary care docs- most are from Britain, Germany, India, and Canada. (They come here apparently for quality of life and practice.) It appears that NZ docs either don’t choose primary care or go elsewhere to make more money. The shortage in NZ is why it was relatively easy for me to get licensed to work here.

Specialty care is a two tiered system. If you are in a good job with insurance, or can afford to buy health insurance yourself, you can get in to most any specialist in a short time (waits about like in the US). But if you are lower income or no insurance, you will wait 4-6 months to see a surgeon, cardiologist, derm, etc. I have had a few letters back from specialists’ offices saying they simply cannot see the patient. So primary docs have to carry the complex case hoping things don’t get much worse.

One recent case was a 30ish year old man with an ulnar nerve entrapment at the elbow that had failed to improve after physio and multiple steroid shots. His hand was half numb and slightly weak but the surgery office sent a letter back saying their backlogs were too great and simply could not see him… There seem to be enough specialists, they are just not happy with the payments for public work. Many see half public and half private, and some see only private. The government does not appear to regulate this.

I should also say something about this rural practice. I am in a two doc practice and there are 4 other GP’s in town, and we all share 24 hour call. There is a small 13 bed hospital. When the hospital charge nurse oriented me she mentioned that one of the two stretchers in Emergency was able to have xrays taken with the patient on the stretcher. She gave the example of when a patient has a hip dislocation, and said that with those I might have to put the patient on the floor to muscle the hip back into its socket - I told her that was a little out of my league. She said, “no worries, the two older GP’s (one is a 62yr woman) can do it” (!!) So it’s an interesting mix of “bush medicine” and the 21st century.