Polity by Rob Salmond

42

Land of the brave little kids

My former colleague Sarah Austen-Smith recently posted some observations from her experience of America. I had an experience last weekend that caused me to think about the same NZ vs US comparison from another perspective: health care.

Of course, a lot has been written about this before. Their system is more than twice as expensive, their system is very bureaucratic, our system delivers better population-level results, and so on.

Our system generally comes out looking pretty good. But those broad comparisons don’t tell the full story.

First, there are things the US health system does better than ours. If you’re really sick, with a rare disorder, you want to be living in the US, not New Zealand. I saw this sharp end of the American medical system first-hand caring for my late daughter Sophie, and it is very impressive.

The US has many of the best specialist doctors and largest, most successful specialised hospital units in the world. The reasons are fairly simple: salaries and scale.

As a general tendency, the larger and more specialised your unit, the better your chances, because the doctors are more likely to have seen lots of cases like yours before. Practice makes perfect and all that.

That’s why those New Zealanders advocating for a South Island Starship hospital are so mistaken. Having two high-complexity children’s hospitals rather than one dilutes our expertise, meaning if your kid gets a rare disease, the doctors you see are less likely to have seen it before. They get less practice, which means the treatment is less perfect.

Yes, South Islanders will travel less time to see their sick kid in the hospital. But it’s more likely their kid will die, too.

I’ve often wondered why New Zealand’s system of escalation for really complex illness goes usually to Australian hospitals first, then to British ones. US hospitals are closer than British ones, and are often better, too, due to scale. Why not send the really complex kids to Australia first, then to the US?

So the US system is better at some big, complex things. How about small things?

This weekend my little Miss 2 presented with an angry rash. Our home medical centre was closed, so I packed Miss 2, Miss 4, and myself off to Wellington urgent care.

I’ve been to urgent care in the US, so I thought I knew what was coming. I packed my computer, DVDs, books, colouring pencils, toys, and food. I expected a four-hour adventure.

I’d made my first visit to American urgent care after picking up a hot charcoal briquette like a drunk dunce. I sat with a burning hand in the waiting room at UCLA. Several people came past with GSW. They got priority. Fair enough. Four hours later I went home, unseen.

I went a few times with Sophie, starting when she was 16 days old. She’d got out of hospital the day before, and promptly developed symptoms the specialists had told us to look out for. She was immune compromised, but it took an hour in the waiting area before we got a room, then four more hours before an overworked junior doctor sent us home, looking out for more of these same symptoms.

Other trips with Sophie got a bit better in terms of treatment – as parental Bolshie-levels rose towards 11 – but no better in terms of efficiency.

On all these occasions, there were complex insurance forms to fill out, and co-pays to pay or co-pays to argue about for months and then not pay.

Last weekend’s Wellington urgent care adventure wasn’t like that. At all. From leaving my house to getting home again was 57 minutes. I filled in one name/address-type form on arrival, then Miss 2 was seen by the nurse within 10 minutes of arriving, then 10 minutes later we saw the doctor. The doctor prescribed some antibiotics straight away, which I got filled in 5 minutes in the pharmacy next door.

No money changed hands.

And, even though some New Zealanders do pay to see the GP, we don’t pay as much as the “free” GP visits included with American health insurance plans, because the plan itself is massively expensive (average cost well over $1,000 a month for a family), and economists generally agree this is mainly money that would have otherwise gone into salary, especially for modest-wage workers.

I think our health system is better than the US’ for most people, but not for all people. But that’s no reason to ignore all lessons from the US, nor a reason to avoid all parts of the US system. Some of our sickest Kiwis need US-level care, and we’ve got the means to give it to them.

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