Health Insurance in New Zealand Amanda Sutherland

Auckland, NZ Largest city in NZ Population 1.5 million (32% of total NZ population)

Auckland City Hospital Largest public hospital in New Zealand Tertiary referral center 710 beds

Paying for Healthcare Healthcare costs are expected to rise by ~8% worldwide in 2018 Aging global population is increasing burden on all healthcare systems Many healthcare models exist including solely public systems and systems primarily driven by private insurance

Rationale American health care continues to be a greatly debated topic even on an international level New Zealanders are extremely proud of their public health system Ultimately, there are pros and cons for different philosophies and systems

Health Insurance in NZ Both public and private health insurance options All citizens are eligible for public health insurance Private insurance offered through employer or purchased personally (accounts for ~%5 of health care spending) No deductible for public insurance Covers preventative care, inpatient care, medications, home services, hospice, and disability

What’s the problem? Clinical Priority Assessment Criteria (CPAC) Assigns number to designate urgency for elective surgery and specialist care Based on clinical, patient, and social benefits Designed to create more standardized and transparent method to prioritize patients Physicians feel it is ineffective and inconsistent and that their clinical judgement is better Wait times- based on CPAC Specialist appointment: 4 months Elective surgery (from specialist appointment): 6-16 weeks Cancer treatment: < 4 weeks

But does it work? In 2017, NZ life expectance was 2.72 years longer than the US In 2012, NZ health expenditure per capita was $1,537 less than the US

Can it be improved? Prioritization of emergency and cancer treatments Once diagnosed with cancer, goal is to begin any kind of therapy in less than 4 weeks Private insurance holders can schedule outside of prioritization scoring Incentive to purchase private insurance Ministry of Health sets annual goals to decrease waiting times by targeting an increase in elective surgical procedures

Conclusions NZ primary care physicians carry much of the burden in health care Long wait times to see specialists or schedule elective procedures Able to bypass wait times if you can afford private insurance- not an even playing ground for everyone and incentive to purchase private insurance Prioritization of emergency and cancer care is effective Many clinicians find prioritization scoring ineffective and not clinically correlated Longer life expectancy with less spending per capita in NZ compared to US

Clinical Experience Many resections of head/neck cancers involving large areas of the face and requiring extensive reconstruction with free tissue flaps Weekly tumor board consisting of surgeons, medical oncologists, radiation oncologists, dentists, diagnostic radiologists, and pathologists. All patients were interviewed and examined with entire team in classroom-like setting *Not my patient, representative photo*

Cultural Experience Many signs stating the university and hospital take a zero tolerance policy towards any kind of discrimination. Other signs placed in operating theaters that the expectations were to always remain professional and not create environment of hostility. I saw no evidence of discrimination or hostile work environments.

Exploring NZ Ben Lomand, Queenstown, NZ Bridal Veil Falls, Waikato, NZ Sheep in Kerikeri, NZ

References https://www.dreamstime.com/stock-photo-aerial-view-auckland-city-hospital- auckland-nz-oct-oct-s-main-image34412940 http://twjfoundation.org/fellowships-sidebar/auckland-city-hospital/ http://aon.mediaroom.com/news-releases?item=137657 https://www.health.govt.nz/our-work/hospitals-and-specialist-care/elective- services/questions-and-answers-elective-services#7 https://itdoesnotaddup.com/category/free-market-in-healthcare/