medical care in new zealand is a provided by a network of public and private providers and insurers.
the primary insurer is the national government. the national plan provides deeply subsidized day to day care (a trip to the gp is about $25) and free coverage for acute (appendicitis) and chronic (arthritis requiring hip replacement) care. care is provided by private doctors and public hospitals. no surprise that there is more demand for care than the system can provide. so procedures that would likely be viewed as required by the patient (arthritis requiring hip replacement) is considered elective. the commitment from the system is to see a specialist within 6 months and within the next months either begin treatment or be told that it is not required and will not be provided. the system may seem a bit cold, but it does avoid the issues they have in other government run systems like in canada or the uk where you can be on a waiting list for ages without a sense of when (if ever) you will get treatment.
prescription meds are handled by a separate government agency, pharmac, that gets a fixed pool of money each year to buy meds for the country. any med covered by pharmac is just $5 at the pharmacy. the advantages are that you have one agency negotiating the best price and selecting the mix of meds that gives the most benefit to the most people given a fixed pool of money. the downside is if the drug you want/need is not on the list. this became a reality this year when a promising breast cancer med was not placed on the list due to its extremely high cost. adding it would have meant that a much larger pool of people would have been denied their meds. the fixed money pool dilemma. makes sense unless you are the person being told no. my experience is that in the states they just add everything – and have the budget run over. no tough decisions. deal with it tomorrow. “hey grandma – remember who gave you your cheap meds at election time”
anything related to an accident is covered by another government agency – the accident compensation corporation. they cover all medical bills, rehab and any lost wages. very comprehensive actually. and what makes it work so well is that it creates a no fault system. in exchange for being covered you have no ability to sue for damages (actual or punitive). unfortunately that means that no more full page ads in the yellow pages or late night tv adverts for personal injury lawyers. the acc covers anyone in nz including tourists.
the final piece in the puzzle is optional private health insurance by companies such as southern cross. they provide coverage for timely access to private doctors and hospitals for treatments considered elective by the national system. you can see an orthopedic surgeon and have that hip replaced in a private hospital right away. they can also provide some coverage for day to day care but that will only make sense for folks that know they won’t budget for medical expenses and need it done for them ($400 additional premium for $400 dental care coverage). the private insurance plans do not anything covered by the national plan, pharmac or acc so they are always your primary coverage.
i signed up for a plan with southern cross that provides solid coverage for the unexpected (surgery, cancer, etc.) but no day to day. my premium per paycheck (fortnightly) – $17