Thursday, December 1, 2011

Lake Taupo Cycle Challenge






Michele and I met her sister Alicia and Alicia's husband Matt and we all did the Lake Taupo Cycle Challenge. It's 95 miles around Lake Taupo with 4000 feet elevation gain, and this year was made more complicated by 50 km/hour winds. Big smiles when we crossed the finish line!

Thursday, November 3, 2011

Accident Compensation Corporation

More about medicine in New Zealand. Any accident or injury that happens on New Zealand's soil to anyone (you don't have to be a taxpayer or NZ citizen) is covered by the Accident Compensation Corporation or ACC. It was started in the early 1970's and essentially people traded the benefit of having an injury covered for losing the ability to sue for damages except in extreme situations.

http://www.acc.co.nz/about-acc/overview-of-acc/how-were-funded/index.htm

It's funded by taxes that come from wages, payroll, petrol taxes and vehicle licensing taxes. It's divided into 5 categories depending upon whether the accident happened at work, on the roads, to a wage earner, to a non wage earner, or due to "Treatment Injuries" which used to be called "Medical Misadventure."

When someone comes in to see their GP with an ACC injury, an electronic form is filled out with all the details of the injury, where it occurred, etc. This is electronically filed with the ACC. The ACC then covers the cost of the doctor visits, medical imaging, hospitalization, visits to the specialists (they're seen within the private system so they get seen faster), and covers lost wages for those who can't work and can also cover additional help that is needed at home for care etc.

It is fully funded each year for all the anticipated future costs of each injury. Since some injuries are permanent and someone may lose 30 years of employment, the money for this is set aside now and invested so that it's covered and future generations aren't stuck with the cost of an injury that happened many years before.

There is an incredible amount of data generated regarding the injuries, where they occurred, etc. You'll see billboards on bus stops saying "41,232 New Zealanders slipped and fell in the bathroom and injured themselves last year." with information on what you can do to decrease your risk of injury. Bike helmets are required for anyone riding their bike, seatbelt use is mandatory, and it's against the law to talk on a cellphone or text while driving.

The other interesting offshoot is in medical malpractice. Since any injury caused by "Treatment Injuries" is automatically covered, one doesn't have to sue their physician and demonstrate negligence to recover damages. Thus one is automatically cared for without cost, your income is covered if necessary, and there is no need to resort to litigation. It is extremely rare for physicians to get sued here for medical malpractice. Therefore, my medical malpractice insurance is $1200 per year as opposed to about $14,000 a year in the states. Of course there is still a complaint system in place for patients that have complaints about the care they've received. Each of these complaints is reviewed by the proper medical board and there's a separate disciplinary system that is available if necessary.

My medical malpractice carrier also covers physicians in the UK and many other countries. They send out a regular mailer talking about cases and damages, etc. They regularly talk about what a great system the ACC is and how it would be a vast improvement if adopted in the other countries they operate in.

More Aussie pix





Aussie vacation






Since we're so close we had to explore a bit of Australia for vacation (and because it's warm and sunny there this time of year). Did some surfing in Byron Bay, Ben talked James and I into skydiving from 14,000 feet. (Very strange to see your son going out that door at 14,000 feet!) Happily we all landed safely--what an adrenaline rush! Went to Aussie's version of Disneyland (Dreamworld) and went to Steve Irwin's Australia Zoo. Spent a couple days in Brisbane which is a great city. Our visit coincided with the Queen's visit but we didn't brave the crowds to see her. We did get to see New Zealand win the Rugby World Cup at long last! (Last won by New Zealand in 1987).

Saturday, October 15, 2011

Occupy Wellington comes to New Zealand






October 16, 2011

Interestingly, the US has the widest discrepancy between the haves and the have nots of any developed country, the top 1% control 30% of the wealth, Sweden is next with 1% controlling 18% of the wealth, New Zealand is next with 1% controlling 16% of the wealth. Here are some shots from occupy Wellington.

Saturday, October 1, 2011






Went to see the NZ All Blacks play Canada in the Rugby World Cup tonight. NZ is ranked #1 in the world in rugby and the World Cup is on home soil so there is a lot of pressure for them to win it all. They didn't have any problem with Canada tonight, but the knockout rounds are coming up. One of the photos is of Ma'a Nonu, a star of the team who didn't play tonight but happened to sit behind us.

Friday, September 23, 2011

Rugby World Cup USA vs Australia







James Michele and I and a friend of James' went to watch tonight's World Cup match against #3 in the world of rugby Australia. The best score was the beginning score, though the US did score a try and put forth a good effort. The vast majority of people in the stands were pulling for the US. I think this was both because they were rooting for the underdog and they have a long standing rivalry with the Aussies. (Clever is the name of the US team captain.)

Thursday, September 15, 2011

More on Medicine in New Zealand




The Government funds health care for everyone in New Zealand. The country is broken down into District Health Boards which fund the local hospitals, GP's and specialists. They spend somewhere between $2000 and $3000 per person per year depending on which District Health Board the person resides in. The difference presumably is due to differences in disease burden and how rural the location is--the more rural the location the more they have to pay physicians and locums to get them to practice there. Overall despite universal coverage, New Zealand spends only 8.9% of its GDP on health care compared to 15.2% for the US (and despite the US spending the highest percentage of GDP on health care of any country in the world, there are still 40-50 million Americans without any coverage, we're ranked 37th out of all developed nations as far as health care outcomes, and over 60% of current bankruptcies in the US are caused by health care costs). If you are interested in reading more about how different countries have decided to set up their health care system (all Western Countries in the world provide some form of universal coverage except the US) I strongly recommend the book by T. R. Reid "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care."

So how is it possible to offer universal coverage at a lower cost as a percentage of GDP in New Zealand? It starts with a strong primary care base. Everyone in New Zealand is enrolled with a GP, and there are 4,000 GP's across the country. Each GP gets a certain amount of money per patient enrolled in their practice per month. In addition they collect copays from patients when they come in for office visits. These range from 0-$15 in a high needs clinic like the one I'm working in to $40-50 in a higher income area. (The high needs clinics get a higher amount per patient per month to make up the difference.) Patients can freely choose their GP's. Most GP offices seem to be in small groups of 3-6 GP's with the solo doc offices becoming less common. GP's can own their own practice or work as an employee for a clinic. A very high percentage of GP practices use an electronic medical record, and they are often tied into their local hospital so they can look up details of their patients hospitalizations and ED visits. Pediatricians and Internists are used more as consultants here and not as Primary Care Providers. They are typically hospital based and also have an outpatient consultative practice. A high percentage of deliveries are done by midwives. Patients aren't able to self refer to specialists; they must be referred by their GP.

The government aggressively controls pharmacy costs by "fully funding" certain medications so that the patient only pays $3 per prescription for a 3 month supply. The formulary tends to have 1-2 generic medications in each class of medication--I haven't found it to be too restrictive. They also fully fund some brand name medications if they feel it will lower the overall health care cost for the country, an example would be Chantix to help someone quit smoking. They also further control their costs by only letting certain specialists prescribe high cost medications that are used for limited uses, for example MS drugs have to be prescribed by a Neurologist, etc. Also, they have a "Special Authority" system so that I can prescribe Fosamax for a patient, but only if the patients T score is below a certain number and their fracture risk is above a certain number. They also limit ordering of certain imaging tests. MRI's can only be ordered by specialists, though they use ultrasound as a cheaper imaging modality much more often here. As a GP I am able to order an ultrasound to rule out a rotator cuff tear for example. They also provide regular feedback on how your prescribing and lab ordering practices compare to the other 4000 GP's around the country.

Seeing a specialist is covered as well if you are referred by your GP, though the drawback is the wait. When I do an electronic referral to get a patient in to see a specialist in the public hospital, I put whether the problem is urgent, semi-urgent or routine. The waits for these categories are 1 month, 1-3 months, and 3-6 months respectively. However, if something is truly urgent there's always the option to call the specialist and they can either see the patient in the Emergency Department or fit them in in the next day or two. The patient can also choose to pay out of pocket to see the specialist, and the fee is generally $100-150 for an outpatient consultation. Some patients have private health insurance that covers seeing private specialists--the main advantage being that they can get in to see a specialist in a week or two no matter how urgent their problem. This way they can bypass the wait to see the public specialist.

There is no charge for hospitalizations and ED visits are covered though there is a copay.

Patients here freely choose their GP and their only out of pocket expenses would be for $3 copays for medications, GP office copays, ED copays and in some cases charges for imaging procedures. Hospitalizations are free.

There is another parallel system that covers all the costs for any accident or injury that occurs on New Zealand soil no matter if the patient is a New Zealand citizen or resident; it's available to anybody who gets injured in New Zealand. More on this in a later post.

Friday, September 2, 2011

A Hike around Miramar Peninsula, Wellington






The photos show shots from Miramar Peninsula which is part of the city of Wellington and shelters Wellington Harbor from the open ocean. One of our favorite bike routes goes around the point following the water. The ferry is coming back from the South Island and goes between Wellington and Picton near Nelson.