1. Pediatric Surgery Starship Children’s Hospital Auckland, New Zealand
Wade Billings, MS4

2. Auckland, New Zealand (NZ)
Population 1.6 million
1/3 of the NZ population
Settled by Maori in 1350s, by English in 1830s
International city, ~40% of population born oversees
significant proportion of UK, Chinese, Indian, Southeast Asian, and South African immigrants

3. Auckland, NZ

4. Starship Children’s Hospital
Opened in 1991
First and largest children hospital in NZ
219 beds
Teaching hospital (University of Auckland)
Many pediatric specific subspecialty services
Cardiology, Hematology/Oncology, Dermatology, Developmental, Endocrine, Emergency, ENT, Gastroenterology, Hepatology, Genetics, Radiology, Immunology, Allergy, Infectious Disease, Nephrology, Neurology, Neurosurgery, Nutrition, Orthopedics, Rheumatology, Respiratory, Nephrology, General Surgery, Urology

6. Topic of Interest Socialized Medical System Financing Services covered
Patient satisfaction
Quality of care
Physician satisfaction

7. Financing Healthcare 11% of GDP spent on healthcare (17.8% in US)
$4,018 per capita spent on healthcare ($9,990)
Lowest amount of per capita healthcare expenditure of 14 developed countries
Public and private hospitals
Public are operated by Ministry of Health’s District Health Boards
Private insurance available, but expensive and exclusive of certain conditions
Co-pays for office visits by individuals or private insurance

8. Service Coverage
Hospital and specialist care totally covered if referred by general practitioner (GP, the equivalent of a primary care provider)
Does not include most cosmetic procedures, some elective procedures, robotic surgeries, most new to the market medications
Quota on procedures allotted to each hospital per year with aim of helping those most in need
Waiting list
Pharmaceutical Management Agency of New Zealand (PHARMAC) determines which medications are subsidized
Ambulance coverage (via charitable organization)
Personal injury/disability care also covered (no personal injury lawsuits)

9. Patient’s Viewpoint
Patients with chronic disease generally like the care they receive
Exception: desire/need for new medication is a challenge
Patients who are generally healthy also like the care
Exception: desire/need for elective procedure such as cosmetic, joint operation, etc. but who lack means of obtaining private insurance or other means of paying
Based on personal conversations with patients, families, medical professionals, and general public

10. Quality of care Life expectancy: 81.6 (17th, US 31st)
Maternal mortality rate: 11/100,000 (39th, US 46th)
<5 year old and neonatal mortality rate: 5.7/1,000 (42nd, US 44th)
Probability of dying from 4 main non-communicable disease between 30 and 70 years old: 10.7 (11th, US 41st)
Heart disease, cancer, respiratory disease, diabetes

11. Physician Satisfaction
Interview of Dr. Neil Price – Pediatric Surgeon
Overall very happy with system and quality of life
Enjoys flexibility in the scope of his practice, but location is limited due to subspecialty practice
Substantial paid vacation per year (6 wks), with protective time during each week for his duties
Feels fairly compensated compared to public, but not as much compared to other subspecialists compared to the level of “good” they provide
Burnout can be an issue

12. Overall Comparison of NZ to US Healthcare
NZ spends less than half of US
Better outcomes than US
Comparable patient and physician satisfaction