A series about health care systems and the practice of emergency medicine across the world

In this series, we’re going to talk about various countries and how they compare to the United States as representative prototypes to structure and finance care; the first of these prototypes, as described in the book, The Healing of America by T.R. Reid, is the National Health System model.

In the United States, we have our own version of this prototype called the Veterans Affairs (VA), where essentially, if you work for the VA, whether you are employed directly by the federal government or your group is under contract with them, you’re essentially acting as an agent of the federal government delivering care to veterans. The hospitals and clinics are all owned by the government. And the financing is typically through broad-based taxation. There are several countries that do this; England, Spain, and Italy are prime examples.

New Zealand is also a country that utilizes a National Health System structure. It is a publicly funded system, administered through 20 different regional authorities, which began in 1938 with the passage of their Social Security Act. The New Zealand system includes benefits like inpatient care, outpatient care, mental health, long-term care, prescription drugs, maternity, physical therapy, medical equipment, home health, and hospice. It doesn’t include benefits like adult dental care, eye care, and orthodontics.

New Zealand’s system is financed mostly by taxes with the national government setting an annual budget and a benefits package. Patients do have some copays, which seem to be small, maybe $10 to $34 USD, on average. And they do all of this for only 9 percent of GDP, which is about half of what we spend in the United States on our health care system in terms of our percentage of GDP.

I spoke with Ryan Radecki, MD, FACEP, the author of “Pearls from the Medical Literature” column, because after spending many years in the United States, he is currently living and practicing in New Zealand.

Does New Zealand have similar challenges regarding getting follow-up care for your patients or making sure they can get access to medications or access to specialists, like we do in the United States?

Dr. Ryan Radecki: Access to primary care has traditionally been something that’s one of New Zealand’s strengths. It’s been very easy to get access to primary care for either routine checkups or urgent visits or hospital follow-up. It’s a little more challenging as of late because the borders have been closed and it’s been a little bit harder to access some of the specialists and medical resources that New Zealand depends upon from overseas. Interestingly, about 20 percent to 30 percent of their physician workforce is born overseas, so they really do depend on foreign trained doctors as the foundation of their healthcare system.

New Zealand has all the same medications that the United States has as far as the basic [ones]. There’s absolutely no trouble getting access to a specialist—at least in the hospital/acute care setting—to perform emergency surgery, acute intervention, interventional radiology, or anything else the patient needs at this particular tertiary hospital that I work at. However, there is, I think, one dermatologist for the entire South Island. So, if a patient is trying to see a dermatology specialist in the publicly funded health care system, they can end up with some pretty long wait times.

Before moving to New Zealand, you worked at a public hospital system in Houston, Texas. If you’re trying to consider how hard it is to see the dermatologist in New Zealand versus the public hospital system in the United States, is it harder, easier, or about the same?

Dr. Radecki: I’d probably say it’s very similar. And the difference being that most people in the United States don’t access the public health care system for their health care needs. Also, about a third of the people in New Zealand also buy a private healthcare insurance policy that allows them more rapid access to some of these specialists (like dermatology) or decreased wait times on some of their elective procedures.

Speaking of the wait times on elective procedures, how would you say they typically compare to what you would see in the United States?

Dr. Radecki: Again, I think it all depends. Hip replacements or knee replacements take time. Elective cholecystectomies, these things take time in New Zealand. Certainly, it’s nothing like the private system in the United States, where if you had a little bit of a biliary colic and you go to the emergency department, you might have your gallbladder taken out that day.

Would you say medications are also cheap in New Zealand, too?

Dr. Radecki: When you write a patient a prescription, their co-pay is quite small. And then if you have a specific type of community services card or if you’re in a lower socioeconomic income bracket, then obviously it’s even closer to free. The New Zealand Formulary determines what the public system covers. So there are a limited list of medications I can prescribe. But then again, you don’t need access to every different iteration of ACE inhibitor, for example.

Some things make sense, like [limited availability of] boutique cancer drugs, but some of things are a little bit more controversial, like these SGLT2 inhibitors for diabetes, which are fairly common and pervasive in the United States. These are just getting approved in New Zealand right now through a cost/benefit discussion, because they do end up on the more expensive side of things, but they also have well demonstrated cardiac benefits.

For the most part, 99 percent of the things that emergency physicians would see on a regular basis are also seen here in New Zealand.

As an emergency physician, do you feel there’s any medication you wish you had over there that you don’t have access to?

Dr. Radecki: They don’t have Ketorolac. They do rectal diclofenac as their alternative for intramuscular ketorolac for renal colic. They have a solution for everything. It’s just not the solution that you’re used to in the United States.

What has your experience been as a patient in the health care system?

Dr. Radecki: We’ve accessed the outpatient GP system, just for before school checks for our kids. There’s a dental service that comes around to all the schools and does dental checks on all the kids and refers anybody for a specific dental follow-up if they need additional cleaning or treatments, and that’s all free and publicly funded as well. And then my family members—who have tried to access the system—have had no trouble getting appointments and no trouble getting the procedures and tests that they needed, and we’ve had our results in a timely fashion. We haven’t run up against any delays accessing our health care through the public system.

What is the greatest lesson you’ve learned that might inform people back home, listeners, or maybe even policy makers, on how we could restructure our health care system in the United States?

Dr. Radecki: I think the most obvious value or endorsement of universal health care is that it’s publicly-funded, regionally administered, and [delivered by] 20 different regional authorities. People [here] are advocating to move the United States to one of these publicly funded models, but nobody is saying, “Let’s tear that up and leave some of our population uncovered and switch the United States model.”

In New Zealand, it blows their mind that the United States cannot somehow all get together and fix the system. The thought of medical bankruptcy, that you might run out of money, that you might lose your health insurance because you’ve lost your job, is just insane to them. And that people who are effectively in their greatest hour of need, whose families are suffering the most, have to have that suffering compounded by the issues with the health care system.

Is there anything else you want to tell our readers about New Zealand?

Dr. Radecki: It’s a great place to work and it’s probably the most fun I’ve had practicing medicine in a long time. And I think that, certainly, it’s a lot more fun than practicing medicine in the United States over this past year. I encourage everyone to come visit once the borders are open. It’s just lovely.