life insurance in New Zealand

The healthcare system of New Zealand has undergone significant changes throughout the past several decades. From an essentially fully public system in the early 20th century, reforms have introduced market and health insurance elements primarily in the last three decades, creating a mixed public-private system for delivering healthcare.

• The Accident Compensation Corporation covers the costs of treatment for cases deemed 'accidents', including medical misadventure, for all people legally in New Zealand (including tourists). The costs are recovered via levies on employers, employees, petrol and vehicle registration, and contributions from the general tax pool.
• The relatively extensive and high-quality system of public hospitals treats citizens or permanent residents free of charge and is managed by District Health Boards. However, costly or difficult operations often require long waiting list delays unless the treatment is medically urgent. Because of this, a secondary market of health insurance schemes exists which fund operations and treatments for their members privately. Southern Cross Health Insurance, a non-profit-scheme, is the largest of these at about 60% of the health insurance market and covering almost a quarter of all New Zealanders in 2007, even operating its own chain of hospitals.
• Primary care (non-specialist doctors / family doctors) and medications on the list of the New Zealand government agency PHARMAC require co-payments, but are subsidised, especially for patients with community health services cards or high user health cards.
• Emergency services are primarily provided by St. John New Zealand charity (as well as Wellington Free Ambulance in the Wellington Region), supported with a mix of private (donated) and public (subsidy) funds.

In 2012, New Zealand spent 8.7% of GDP on health care, or US$3,929 per capita. Of that, approximately 77% was government expenditure. In a 2010 study, New Zealand came last in a study for the level of medications use in 14 developed countries (i.e. used least medicines overall), and also spent the lowest amount on healthcare amongst the same list of countries, with US$2510 ($3460) per capita, compared to the United States at US$7290

Structure

The Ministry of Health is responsible for the oversight and funding of the twenty District Health Boards (DHBs). These are responsible for organizing healthcare in the district and meeting the standards set by the Ministry of Health. Twenty-one DHBs came into being on January 1, 2001 with Southland and Otago DHBs merging into Southern DHB on 1 May 2010.

The boards for each DHB are elected in elections held every three years, with the exception of one of the eight board members, who is appointed by the Ministry of Health.

The DHBs oversee the forty six Primary Health Organizations established throughout the country. These were first set up in July, 2002, with a mandate to focus on the health of communities. Originally there were 81 of these, but this has been reduced down to 46 in 2008. They are funded by DHBs, and are required to be entirely non-profit, democratic bodies that are responsive to their communities' needs. Almost all New Zealanders are enrolled in a PHO, as there are financial incentives for the patients to become enrolled.

The Northern Region DHBs also use shared services provided by the Northern DHB Support Agency and HealthAlliance. These services deliver region wide health initiatives and shared IT services and logistics.

The Canterbury District health board has been successful in redesigning services to reduce hospital use. Some of this transformation was precipitated by the 2011 Christchurch earthquake when several healthcare buildings were damaged or destroyed. It now has lower rates of acute medical admissions, low rates of average length of stay, fewer readmissions in acute care, fewer cancelled planned admissions and more conditions treated out of hospital.

Public vs. private payment

Hospital and specialist care in New Zealand is totally covered by the government if the patient is referred by a general or family practitioner and this is funded from government expenditure (approx. 77%). Private payment by individuals also plays an important role in the overall system although the cost of these payments are comparatively minor. Those earning less than certain amounts, depending on the number of dependents in their household, can qualify for a Community Services Card (CSC). This reduces the cost of after-hours doctors' visits, and prescription fees, but no longer reduces the cost of visits to a person's regular doctor.

Injuries which occur as a result of "accidents", ranging from minor to major physical but including psychological trauma from sexual abuse are generally covered by the Accident Compensation Corporation (ACC). This may include coverage for doctors visits and lump-sum payments.