Agree. NZ has something pretty close to a sweet spot in combination of public and private provision.
For the benefit of the (thankfully) innocent: 'GSW' in the middle of Rob's article refers to Gun Shot Wounds.
My daughter and a friend's son were diagnosed with leukaemia about the same age although we were in Wellington and he was in the US. His treatment seemed to be much more intense and longer with long stays in hospital and chemo via lumbar punctures. My daughter's was administered via a butterfly in her hand. (This was a few years ago and standard treatment is much gentler now). We were home most of the time, hospital stays were rare, and she went to school as much as she felt up to it. It seemed like they had more or less the same type of illness but the US treatment seemed much more all encompassing and risk averse while ours seemed was much more relaxed and child centred. Ours was all free as well as access to free counselling, household help, childcare etc. Theirs was very expensive. I am probably totally wrong about all this but just my impression at the time.
I could've done with counselling, childcare and household help back in the day, but I guess it shows we are constantly improving. Or more likely it's because Cancer.
We have a great medical care system with a few problems which tend to be addressed over time. Complex cases and rare diseases are problematic. Not because we don't have the expertise or access to expert knowledge but at least partly because our specialists tend to expect to be a one-stop shop, they are often reluctant to collaborate with other specialists , which is a problem when you're dealing with a body that has failures in more than one system or with rare disease. But we don't pay through the nose for care and we all have access.
more likely it's because Cancer
Even they don't have things sorted yet. Current Ombudsman and former Health and Disability Commissioner Ron Paterson delivered a great presentation recently about the experience of our late colleague Judi Strid as she dealt with cancer as a patient rather than an advocate - 12pg transcript or ..
as parental Bolshie-levels rose towards 11
How often, I wonder, are the outcomes for the child proportional to the Bolshie levels of the parent?
I recall an A&E Head Honcho on telly years ago, after the death of a child who had received dismissive attention from a hospital A&E, saying that parents who felt their child's illness was not being taken seriously enough should kick up shit. Like, they don't really have those "We Will NOT Tolerate ANY Verbal Or Physical Abuse" signs all over the place. Like, "its kinda your fault we didn't take your child's meningitis seriously."
NB...I have read way too many Health and Disability Commissioner reports.
I get your point about consolidating expertise in one facility...but...are there any stats/research on how the presence of family affects outcomes for the child? Or the stress levels of family (with having to travel the length of the country, losing their jobs etc) affecting the child's recovery?
Surely with the Interweb, collaboration and consultation with experts all over the world should be possible...with patients being treated locally unless it is absolutely essential for them to travel.
And, another big difference twixt here and the US is that doctors and nurses who screw up over there get their asses sued. Here, they can stuff up, almost willfully, and we almost never even get to know which hospital they are working in, much less their names.
Angela - that story was from a time when we had a more or less functioning welfare state. Doubt you get offered these things now.,
One comparative aspect where NZ falls short is in not having school nurses. At my primary school in the US, the school nurse was part time on a daily basis. In my secondary school (a larger student roll) the school nurse was full time. I cannot help but think many childhood illnesses as well as instances of physical/emotional abuse of children would be picked up at the early onset stage, and subsequently treated much earlier if we had school nurses.
We crossed comments Sacha...I had heard about this...but godallbloodymighty...Judi's story is as bad as it gets.
Did she make a complaint?
And, another big difference twixt here and the US is that doctors and nurses who screw up over there get their asses sued.
That can have a real downside as well in the US. It is particularly difficult, even if you have written a 'living will', for your relatives to wrestle these decisions away from insurance companies and physician/health care decision-makers.
One of the Young People did their real estate agent course. The very first class involved reading and discussing just how much shit rains down upon the head of an agent who stuffs up.
Switch to the three fourth year med students on 'section' in the Far North.
Had never even heard of the H&D Commission, much less read any decisions, reports or Commissioner recommendations.
I wonder how far through their training do US med students learn about mal-practise?
One comparative aspect where NZ falls short is in not having school nurses.
When did NZ's school nurses go missing? While it's been some time since it's been an issue for me, we certainly had them right through the 80s.
Have not been privy to conversations but I believe Ron is carrying out that responsibility for Judi. As architects of the HDC Code and its execution, the experience must have been upsetting for both of them given how long our health system has had to lift its game.
Oh, the irony.
You know, I'm a stroppy person, and I'm told I project a certain confidence, and I bet my bottom dollar Judi did too....despite her intent to be a 'mystery shopper'.
Those people who are not confident, literate, articulate....do not have family and friends riding shotgun....do not know they have been treated badly, never mind have the right to make a complaint???
How many serious breaches of the Code go un -investigated?
(Thanks for the transcript, interweb struggling, despite new provider.)
I'm a stroppy person, and I'm told I project a certain confidence, and I bet my bottom dollar Judi did too
When did NZ's school nurses go missing?
Not missing altogether but predominantly part time in secondary and not sure what if anything much at primary from what I've read;
Thanks Katharine, I'd just assumed they were still out there. In the 1950s all primary school kids, including those in Catholic schools, had their sight and hearing tested in school time by state-employed nurses. Yet another example of our slow slide from 1st world status?
Having lived in/with both systems I'd like to descibe the experience I had getting my gall bladder out in the US .... I had really good minsurance ... took me close to 6 months to get a referal and then an an appointment with a specialist, 3-4 more months of intense pain futzing around doing diagnostics and trying meds that didn't cost anything, then a sonogram, a diagnosis and an operation within a week.
My wife had the same thing in NZ a decade later, here it was the opposite ... a specialist and a diagnosis within 3 weeks .... then on a (long) waiting list for an operation (after the pain I'd been through we paid the full cost of a private operation pourselves, probably 1/10th what we'd have paid in the US).
Not surprised about the futzing around in the US - my experience is that some specialists and most hospitals/clinics there often milk the insurance for all its worth before getting around to what should have been done many $$$ earlier.
no it's more an issue of the Insurance companies not wanting to spend money on diagnostics or specialists and pushing back at every possible point.
My doctor's practice in the US (5 GPs sharing space) had 4 people working in the receptionist's area, one working as a receptionist and 3 who's job is essentially dealing with insurance companies, my current doctor's practice in NZ (6 GPs I think) has just 1. My US dentist (sole practice) had 2 people working reception. You can see where the costs start to climb just from that.
I read your story about your daughter Rob, and I teared up at work. I hope things are easier for you now.
I'll echo Rob's experience in the US. We were on a good healthcare insurance scheme in the US (University post-doc counts as staff for insurance).
When I fell and damaged my ankle the surgery was with all the bells and whistles as good a care as anyone could hope for. But when I had to go to see my "GP" it was a six week waiting list! I could see a nurse if I was willing to sit and wait in the queue.
There seems to be two parts to this, firstly as Rob points out the US is big, and rich, and has the best medical research anywhere and is capable of providing amazing high level treatment. And again Rob is right, sheer size means that for any disease or ailment there is a specialist hospital somewhere in the country with experts who live, breath and sleep just the one disease. Like Starship is for kids.
But there is a murkier side as well. Most healthcare is paid for by insurance. Insurance companies run for profit, they cut costs, they exclude coverage where possible. Which is what you expect.
But there is a much darker side to having insurance companies pay for everything. The price of everything is sky high. Every single part of a treatment is charged, even the can of coke you drink while waiting. And the price is inflated enormously - because it's OK to rip off and insurance company even for a can of coke at 5 times normal price.
In NZ there is a sense that everyone is sharing the cost and that affects the way most of the medical community charge as well.
Our public health system is struggling with user pays and efficiency drives and cost rationalisation and it is leading us to a system like the US where costs are enormous and IF you have insurance you are OK. But without any the advantages of the US system.
But don't worry - you got a tax cut so it's all OK.
In NZ you do best with both the public and the private system. My folks got medical insurance in the 70s when they discovered they had no hope a getting a routine operation in the public system for my mother's condition that caused considerable discomfort. They had to pay to get it done in one of Hamilton's private hospitals to get relief. Since then our family has always had private insurance sometimes funded by us and sometimes by our employers - including at one stage, Wellington Newspapers, a subsidiary of INL when it was owned by Rupert Murdoch.
I believe there is also a trend towards higher insurance deductibles (excess) in the US. High deductible plans come with a tax advantaged savings account attached to help you save for upcoming costs.
So even if you have "employer provided" health insurance, you're still on the hook for a few thousand dollars before it kicks in. It really is more like the traditional model of insurance - there for big emergencies only.
those US tax decuctable accounts are a bit of a trap, essentially you put a portion of your income in a pre-tax box at the beginning of the year and can take it out to pay for non-reimbursed health expenses during that year ....
The catch is that if you don't empty the box before the end of the year someone (I have no idea who) takes the money - you lose it. It means that people tend to underestimate how much they will spend to a oid this