When I moved to New Zealand, I faced many decisions – where to live, where to open a bank account, and where to receive healthcare. For all three, I consulted my new work colleagues who were generous with information about their own experiences and preferences. Being healthy, the decision I thought the least about but potentially has the greatest long term impact is where to receive healthcare.
When I scheduled an appointment with a primary care provider, I expected a long wait and an inefficient social medicine system. Perception of social medicine in the US often means fewer choices of providers, longer wait queues, and inferior quality. Well, my visit was far better than that.
I enrolled in a primary care practice that was highly recommended by my work friend, and also because of its proximity to my home (less than a 5-minute walk), they offer evening and weekend appointments, and they have a pharmacy on-site. When I made my first appointment, I was offered a slot that week, but chose to wait a week so I could have an evening (6pm) appointment. My selected primary care physician was not my first choice. I would have preferred an older, more experienced physician, though they were not accepting new patients at this time. The physician I chose is new to the practice this year. However, I am in good health, so I felt little risk in seeing her. She was very efficient and answered all my questions, Since our visit two months ago, she has sent me reminder notices to schedule a mammogram and to have my cholesterol levels and HbA1c checked. I give her an “A”. The cost of this visit, since I am on work visa was $59.
To be sure this was a typical experience with NZ primary care, I inquired of others’ experiences with new PCPs in New Zealand. This person answered, “My first visit was in about 1 week after I moved. I wanted to meet my new doctor and make sure I was comfortable seeing her. Also, I needed to know about the centre and surrounding services within the building and the chemist (pharmacist) right next door. It was a well and sick visit, I have a brain injury and a few physical injuries. I needed a new prescription and wanted everything to carry on and to get familiar with the new process and the hours of the centre. The quality of the doctor is great but being a bigger centre booking a doctor there is quite a few days in waiting to see her. The cost is quite expensive being about $38 for a 15 minute visit plus extra costs to get letters or referrals to other services. Costs me $20 to see a nurse. Most of my doctor visits are ACC- related with the cost only a few dollars cheaper than normal visit.“
Clarification: ACC is Accidental Compensation Corporation, formed to help New Zealanders and visitors return to everyday life after an accidental injury, and covers all accident related health expenses. The corporation administers the benefits on a no-fault basis, so that anyone has coverage, regardless of the way in which they incurred an injury. Due to the programme’s no-fault basis, people who have suffered personal injury do not have the right to sue an at-fault party, except for special cases where punitive damages are appropriate.
Medical practices in New Zealand commonly post their fee structure. They give a discount for patients enrolled in their practice and charge non NZ residents more. Sample costs for NZ PCP MD Consultation (15 minutes)
Enrolled Non Enrolled Non NZ Resident
Under Age 6 FREE $20 $95
Age 6-12 FREE $60 $95
Age 13-17 $37 $60 $95
Age 18-24 $48 $85 $95
Age 25-44 $53 $85 $95
Age 45-64 $54 $85 $95
Age 65+ $42 $85 $95
At this practice, patients may be charged more for longer consults and for extra paperwork for letters or referrals. Consults with nurses are $30.
So, how do these experiences compare with the US? Well, that depends on INSURANCE and possibly geography. To explain US healthcare to New Zealanders, I asked three US friends, all Medicare-eligible (over 65) retirees, to share their experiences:
Friend # 1 intentionally chose a young female doctor who appeared to have good credentials. She was able to get an appointment immediately for a well-visit and her insurance covered the cost of the visit except for the $10 co-pay. She did not provide the cost of her insurance, but she is a retired teacher, and a site for Massachusetts retired teachers listed seven options for insurance plans ranging from $300-423/month, with $372/month or $4464/year as the average of all 7 plans. The retirement fund picks up at least 80% of insurance premium depending on date of retirement, so using the average of all seven plans ($372), her monthly contribution would be approximately $74.
Friend # 2 chose a new doctor due to close proximity to her new home. This physician was not accepting new patients, but made an exception for my friend, who waited 3 months for her first visit with the doctor. My friend did not have to pay anything for the visit since it was covered by her Medicare supplemental insurance that costs $639/month, or about $7700/year.
Friend # 3 chose a new doctor based on being female and recommendations from friends. She waited 5-6 weeks and then saw a nurse practitioner in the practice, and an annual physical with the physician was scheduled for two months later. She had not met her Medicare deductible, so she paid $166, then her supplemental insurance pays the remaining 20%. Her supplemental insurance costs $104/month or about $1250/year.
Friend # 4 said she chose a new primary care physician about a year ago and hasn’t heard anything from the provider since.
Two out of the US friends lauded the nurse practitioner in their physician’s office, saying she is a primary factor in satisfaction with their health provider. They see her more often than their physician.
There are many validated statistics available, but to graphically illustrate the five experiences in this article, let’s say we all have good health this year and we see our physician once. I added estimates for government subsidies (Medicare and NZ government funding). According to the Kaiser Foundation, the cost of Medicare per recipient varies by state, but averages approximately $11,000/year (2014). In 2015, the University of Otago published a study of what the New Zealand government is spending on healthcare. Looking at the data in this study at costs for 65+ age group to compare with Medicare, New Zealand is paying approximately $4100 NZ/year per person, or $2870 USD, adjusting for the currency conversion.
Here are the results
When I scheduled an appointment with a primary care provider, I expected a long wait and an inefficient social medicine system. Perception of social medicine in the US often means fewer choices of providers, longer wait queues, and inferior quality. Well, my visit was far better than that.
I enrolled in a primary care practice that was highly recommended by my work friend, and also because of its proximity to my home (less than a 5-minute walk), they offer evening and weekend appointments, and they have a pharmacy on-site. When I made my first appointment, I was offered a slot that week, but chose to wait a week so I could have an evening (6pm) appointment. My selected primary care physician was not my first choice. I would have preferred an older, more experienced physician, though they were not accepting new patients at this time. The physician I chose is new to the practice this year. However, I am in good health, so I felt little risk in seeing her. She was very efficient and answered all my questions, Since our visit two months ago, she has sent me reminder notices to schedule a mammogram and to have my cholesterol levels and HbA1c checked. I give her an “A”. The cost of this visit, since I am on work visa was $59.
To be sure this was a typical experience with NZ primary care, I inquired of others’ experiences with new PCPs in New Zealand. This person answered, “My first visit was in about 1 week after I moved. I wanted to meet my new doctor and make sure I was comfortable seeing her. Also, I needed to know about the centre and surrounding services within the building and the chemist (pharmacist) right next door. It was a well and sick visit, I have a brain injury and a few physical injuries. I needed a new prescription and wanted everything to carry on and to get familiar with the new process and the hours of the centre. The quality of the doctor is great but being a bigger centre booking a doctor there is quite a few days in waiting to see her. The cost is quite expensive being about $38 for a 15 minute visit plus extra costs to get letters or referrals to other services. Costs me $20 to see a nurse. Most of my doctor visits are ACC- related with the cost only a few dollars cheaper than normal visit.“
Clarification: ACC is Accidental Compensation Corporation, formed to help New Zealanders and visitors return to everyday life after an accidental injury, and covers all accident related health expenses. The corporation administers the benefits on a no-fault basis, so that anyone has coverage, regardless of the way in which they incurred an injury. Due to the programme’s no-fault basis, people who have suffered personal injury do not have the right to sue an at-fault party, except for special cases where punitive damages are appropriate.
Medical practices in New Zealand commonly post their fee structure. They give a discount for patients enrolled in their practice and charge non NZ residents more. Sample costs for NZ PCP MD Consultation (15 minutes)
Enrolled Non Enrolled Non NZ Resident
Under Age 6 FREE $20 $95
Age 6-12 FREE $60 $95
Age 13-17 $37 $60 $95
Age 18-24 $48 $85 $95
Age 25-44 $53 $85 $95
Age 45-64 $54 $85 $95
Age 65+ $42 $85 $95
At this practice, patients may be charged more for longer consults and for extra paperwork for letters or referrals. Consults with nurses are $30.
So, how do these experiences compare with the US? Well, that depends on INSURANCE and possibly geography. To explain US healthcare to New Zealanders, I asked three US friends, all Medicare-eligible (over 65) retirees, to share their experiences:
Friend # 1 intentionally chose a young female doctor who appeared to have good credentials. She was able to get an appointment immediately for a well-visit and her insurance covered the cost of the visit except for the $10 co-pay. She did not provide the cost of her insurance, but she is a retired teacher, and a site for Massachusetts retired teachers listed seven options for insurance plans ranging from $300-423/month, with $372/month or $4464/year as the average of all 7 plans. The retirement fund picks up at least 80% of insurance premium depending on date of retirement, so using the average of all seven plans ($372), her monthly contribution would be approximately $74.
Friend # 2 chose a new doctor due to close proximity to her new home. This physician was not accepting new patients, but made an exception for my friend, who waited 3 months for her first visit with the doctor. My friend did not have to pay anything for the visit since it was covered by her Medicare supplemental insurance that costs $639/month, or about $7700/year.
Friend # 3 chose a new doctor based on being female and recommendations from friends. She waited 5-6 weeks and then saw a nurse practitioner in the practice, and an annual physical with the physician was scheduled for two months later. She had not met her Medicare deductible, so she paid $166, then her supplemental insurance pays the remaining 20%. Her supplemental insurance costs $104/month or about $1250/year.
Friend # 4 said she chose a new primary care physician about a year ago and hasn’t heard anything from the provider since.
Two out of the US friends lauded the nurse practitioner in their physician’s office, saying she is a primary factor in satisfaction with their health provider. They see her more often than their physician.
There are many validated statistics available, but to graphically illustrate the five experiences in this article, let’s say we all have good health this year and we see our physician once. I added estimates for government subsidies (Medicare and NZ government funding). According to the Kaiser Foundation, the cost of Medicare per recipient varies by state, but averages approximately $11,000/year (2014). In 2015, the University of Otago published a study of what the New Zealand government is spending on healthcare. Looking at the data in this study at costs for 65+ age group to compare with Medicare, New Zealand is paying approximately $4100 NZ/year per person, or $2870 USD, adjusting for the currency conversion.
Here are the results
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