A number of people have asked me about how healthcare works in New Zealand, and my friend Candida at candidaabrahamson has given me just enough (gentle) prompts to get me to answer this question. Thanks Candida, you’re a star!
For kiwi readers (that’s people living in New Zealand and not our much-loved, but endangered national bird), you’ll know all this but I would love to hear if, and how, your experience differs from mine. Consistency is not always available in probably any healthcare system, so I’m sure there may be some big differences in reality.
Just to clear up any more confusion that might exist, New Zealand is NOT part of Australia. I know Australians often wish they were part of us, but we are actually two separate countries, much like the United States and Canada. And generally we don’t like this issue of our identity to be confused or misunderstood, although I hasten to add that I love my Aussie neighbours (and readers) anyway.
I had to think about this topic because after many years in the health system here I know that my views are slightly tainted by reality. And I guess that’s the case in whichever country you choose to look at their systems. New Zealand has a public health care system, but a private system is also available, and in my experience it is necessary to use both. In a promotion by the immigration service here I was told that my health care needs are in excellent hands. Hmm. I’m not totally convinced but…
I spent a very long time trying to insert in here an image of how our health system is supposed to work, but I’m sorry to say my technological skills were just not up to the challenge of ‘WordPress versus the New Zealand government department responsible for such things’. I don’t think they want me to point out that the government was firmly at the top of the diagram, and I and all the other 4.5 million kiwis were firmly at the bottom of it. No wonder I have so much trouble. Why do patients always come last?
Our healthcare system offers me subsidised access to a General Practitioner (GP) for my general medical needs. I also have access to subsidised prescription medication. Now subsidised doesn’t mean I can necessarily afford it though. Because I am on a social security benefit and have to access both of these on a regular basis, I theoretically receive a disability allowance to meet these costs, but because I have other disability costs (there is a maximum), it actually doesn’t cover the cost of doctors and prescriptions for me. While I have never been unable to access prescription medication, I have regularly been in the situation of not being able to afford to go to the doctor, even though I needed to.
We also have a public hospital system, which involves inpatient, and specialist outpatient services.
I should be seeing the following specialists through this public system.
A Psychiatrist (& social worker/nurse) ×
An Endocrinologist for Graves’ Disease √
A Rheumatologist for Fibromyalgia ×
I was dumped (my word, not theirs. I think the word they used was ‘discharged’) from the public mental health system about five years ago. It previously included free access for me to a psychiatrist and a social worker, as well as access to the outpatient Eating Disorders Service, which included a specialist nurse). I was ‘dumped’ apparently because I was treatment-resistant and wouldn’t respond to the help they had provided to date. Apparently that was my fault, but I won’t get into that now.
Now days I largely survive without these services and pay a hefty price on the occasion that I need to see a psychiatrist (mostly for medication changes) through the private health system, because sometimes my GP just doesn’t know quite what to do. My last appointment cost NZ$345.00 (you’ll have to do your own exchange rate calculations).
I was fortunate to get into the public service for Endocrinology because at the time I was diagnosed I was considered to be ‘acute’. Had I not been, I would have probably waited six to nine months to be seen (during which time perhaps I would have died), or again I would have had to opt for the pricey private health care.
I went directly to the private system for a rheumatologist because I would have waited at least six to nine months to be seen publicly. That appointment cost me about NZ$350.00. It wouldn’t have killed me to wait, but it was not long after the Endocrinology experience and I was getting a little weary of my state of health. Sometimes it’s just not worth the wait.
Mental Health Services
I need to say that most people’s reality of the mental health system is not as checkered as mine. There is a free outpatient service, and generally I think they do a good job. There is also a after-hours crisis service available, and I admit in years gone by I made heavy use of it. Those crisis service staff are always run off their feet, probably like anywhere, and sadly there are people who end up falling through the cracks because of it.
There is free access to in-patient psychiatric hospitals, and I have used my fair share of these over the years. The problem is that again, demand exceeds supply, and the hospitals become a ‘patch up and ship out’ service, rather than any type of therapeutic path to recovery. Unfortunately there is very little in the way of inpatient care for people with eating disorders, and I have sat on waiting lists, but have never been near being admitted for this inspite of previously being dangerously unwell.
Very few private facilities exist for mental health care. I know of one private psychiatric hospital, which operates as a therapeutic community. I have had two admissions there, one for three months and the other for 10 months. It was very helpful to me and it’s a shame that most people never get this opportunity. The first admission was paid for by a family member thankfully, and I was fortunate enough to get rare public funding for the second admission.
Most people also don’t get much opportunity of access to psychotherapy. This is not free in most circumstances, and while there is some government funding to people on low incomes, it tends to be very limited. For example, I was given access to six visits to a psychotherapist to deal with an experience of sexual abuse. Most people could tell you that six visits doesn’t go far.
I pay NZ$100.00 a time to see my psychotherapist. He has kindly lowered his fee for me, as he knows I already go without other necessities to make this a possibility for me. But that is still a lot of money. While it makes for a very tight budget, I consider therapy to be the thing that lead me from death’s door to life again, and so it is worth it. But for so many, this isn’t a possibility and I personally believe that it means that the other services are overused.
New Zealand has a free health service and when I hear stories from other countries, I am grateful for what we have. It means that there is generally something available for everyone, regardless of income and/or insurance. I know that if I am really sick and I need help, I will get it. It’s just that it is difficult to access sometimes, and that sometimes means people continue to go without what they need.
Hopefully that answers some questions, without boring you to tears. If you’re wondering about anything else, ask and I will answer…
To finish, something entirely unrelated to healthcare:
“The United States invented the space shuttle, the atomic bomb and Disneyland. We have 35 times more land than New Zealand, 80 times the population, 144 times the gross national product and 220 times as many people in jail. Many of our big cities have more kilometres of freeway than all of New Zealand, our 10 biggest metropolises each have more people than all of New Zealand, and metropolitan Detroit has more cars on the road than all of New Zealand.
So how come a superpower of 270 million got routed in the America’s Cup, the world’s most technically oriented yacht race, by a country of 3.5 million that out-produces us only in sheep manure?”
– Eric Sharp (1995)
And apparently said of New Zealand. I totally refute it:
“A country of inveterate, backwoods, thick-headed, egotistic philistines”
– Vladimir Ilyich Lenin (1909)