Sunday, April 27, 2014

NZ vs American Medical Systems

If you don't care to hear my thoughts on the pros/cons of the US vs NZ Medical Systems, this isn't the post for you. Thanks for checking in though! We are at almost 9000 views! That's pretty awesome, huh?
But for those of you who are interested in hearing how a socialized medical system works (meaning when healthcare is largely covered by the government through tax dollars), keep reading.

After working in the NZ system for about 8 months now, I've almost got it figured out... which is actually pretty fast because I honestly still don't understand the American system. So round 1 'Simplicity' goes to NZ. Beyond that, I'm pretty split on which one is better. Each has things that I really like, and each has things that drive me crazy.

American System Positives
- Fast!  I've learned that we Americans are quite spoiled when it comes to access to primary care as well as specialty care - ESPECIALLY the specialty care. If you want to see a specialist, you can often contact them directly or your Primary Care Doctor can refer you, and the wait is short. In NZ, the waits can be months. or you may get denied completely.

- Primary Care in America is more interesting. I can order pretty much any test, MRI, CT, etc, and can manage people with a lot of problems. The NZ system limits what Primary Care doctors can order, so I have to refer people to specialists a lot, sometimes just so I can get a CT scan. - more on that later.

-Our cancer screening is better

New Zealand System Positives
- My job is pretty easy. Because I am limited on what tests I can order, meds I can give, etc, I am left with a narrowed scope of practice. So it makes for a cruisey day.

- Visits for Children 5 and under are free. period.

- There is a system called ACC that basically pays people who are off work due to injury. They will pay you a good percentage of your salary while you are injured, but that percentage decreases over time - incentivizing you getting back to work.  They will also help with return to work plans, or do training if your injury makes you not able to ever return to your prevous job. They teach skills so you can get a different job.

- Nurses here have a lot more clinic responsibilities. They see patients for more things that the nurses in the states do. They do all the immunizations. They do skin biopsies. They do liquid nitrogen treatments. The trade-off is that I do my own vital signs for every patient and go get them out of the waiting room and bring them to my one exam room. No waiting for the nurses.

- Documentation is more straightforward and the billing side of things is much simpler. I don't have to focus on stupid things in my notes that are actually irrelevant to the visit for the sole purpose of documenting a 'level 3' or 'level 4' visit. I just have to write what matters here. the notes are shorter and more useful.

- prescriptions are mostly $5.

American System Negatives
- People abusing the disability benefits.

-Documentation is a nightmare. 

- There are a lot of changes happening, which is scary as a primary care doctor. 

- the patients are more argumentative

- more demands on physicians on time, billing, documentation, paperwork, forms, insurance hurdles, etc.

New Zealand System Negatives
- People abusing the ACC/disability benefits.

- My job is too narrowed here. I get frustrated that I can't just order certain tests/studies which would allow me to diagnose and treat things faster than it takes to get someone in to see specialist. If I could order/do more, it would decrease the burden on the specialists and their wait times would be shorter for the people who actually need a specialist.

- Their colon cancer screening system is terrifying. We battle the GI department to try to get people colonoscopies. It's really scary.

- There have been some shocking situations where people are declined services based on their age or level of complexity. And this is beyond what I see as reasonable. 

- it is not rare to have to wait for more than 6 months to see a specialist. a month to get an ultrasound. People do have the option to have private insurance here as well, which is typically faster, but quite expensive.

- with high suspicion of cancer, they have special people who are hired to push people through all the hoops to get them in to the proper specialists, imaging, cancer doctors, and start treatment. Their goal time to get this done is like 6 weeks. In America, that is more like 3 days.

So that's my initial assessment of the situation. In summary, I think the NZ system is better if you are young and healthy. There are systems in place that will give your toddlers free doctor visits. If you get an injury, there is a system in place to help cover you during your injury and to get you back in prime condition so you can get back out in the workforce and be productive for NZ. I think the American system is better if you have multiple medical problems or if you are over 60. America has pretty good coverage for the elderly and for pregnant ladies and their babies. And we can make things happen faster for diagnosing/treating big scary stuff.

and that's that!

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