1. Health Insurance in New Zealand
Amanda Sutherland

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

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

4. 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

5. 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

6. 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

7. 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): weeks
Cancer treatment: < 4 weeks

8. 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

9. 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

10. 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

11. 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*

12. 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.

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

14. References
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services/questions-and-answers-elective-services#7