Dr. Stevens has graciously given me permission to post the full text of his e-mail here. Any American who wants to know what his or her health care future will look like under "universal health care" should read this eye-opening piece:
I am currently on a sort of sabbatical and am working in New Zealand for a public government hospital. New Zealand has a purely socialist medical system although there is also private insurance that can be obtained as well. This is a single payer system from a government ministry that controls all care through District Health boards. Each District Health Board gets a lump sum of money each year to provide for their population.Dr. Stevens is absolutely correct. Americans would not accept the levels of restrictions on access and quality of care caused by New Zealand's government policies.
Primary care physicians (general practitioners) are private contractors and are paid fee for service from the government plus a copay from the patient. Specialists (including radiologists as well as surgeons, pediatricians, internists, cardiology, gastroenterology, urology, etc) are paid a salary which is based only upon the number of years since board certification plus bonus for after hours call coverage.
All specialists are paid the same. The top salary band (15 years + after certification) is about NZ $200.000 which is about $150,000 US. Call coverage can add another 15-25% depending on how busy and how frequent. All New Zealand citizens and permanent residents are covered by the National Health Service.
General practitioners see one patient every 7 minutes and, I am told, can make up to NZ$600K - $800K with their fee for service.
Patients must go first to their GP for all initial care--adult and pediatric. Pediatricians are specialists and only see patients after referral from GPs. All routine obstetrics is handled by midwives who receive 2 years training post high school. To go to the ER you must have a referral from your GP unless it is emergent (trauma, etc).
How does this work? Well, my hospital is over budget for the year, so they are closing the hospital (the only one within a 3-4 hour driving radius) to all but emergent patients for 6 weeks in December and January!! No elective surgery or non emergent patients. I could give many stories about delays in diagnosis that would be unheard of in the US.
That said, patients are generally happy with their healthcare and are glad that it is "free". The mentality of patients here is different from the US. Patients are not as demanding. No one gives a second thought to waiting 4-6 weeks for a staging CT for their newly discovered lung cancer prior to treatment -- many don't accept treatment anyway. If they are told they have a cancer, they just go home to die. They are generally happy for what they have and don't worry (or know) what they don't.
For radiology, I am working in a small rural district, so our waiting times are good, but in many of the urban districts, the waiting times for a routine CT scan are up to 9 months. GP's cannot order CT or MRI -- only specialists. The radiology department runs 8:30 am - 5:00 pm and I read about half of what I would read in the US. If it is not done by 5:00, it doesn't get done until tomorrow. In some cases, it might be weeks until a routine film is read. Call back after hours are pretty much only for trauma or surgical emergencies. Everything else can wait until the next morning, or Monday.
Our department is over budget, because they forgot to include the $35,000 equipment maintenance contract in this years budget. They installed a PACS system but didn't buy the Physicians Hanging Protocol software or the RIS [Radiology Information System] -- they are using a 20 year old system that is no longer supported.
Physicians who live here are generally satisfied due to the light workload and the lifestyle. However, there is a huge brain drain from the country. Many New Zealand doctors emigrate to Australia, Canada, or the US where the pay is better.
The country is critically short of physicians, especially specialists such as radiologists. In my hospital, about 2/3 of the medical staff in not native New Zealander -- most from South Africa or Europe) and about 1/4 of the staff is made up of locum tenens like me -- people from outside of New Zealand who come here for 6-12 months for the experience.
It is an interesting system and I have had an interesting time here. They spend about 1/4 per capita compared to what we spend in the US for health care. The care is good but not great here. They have a hard time recruiting and keeping physicians and are critically in short supply. I do not think that the American public would accept the level of care that is provided here. We will see what our future brings!
Ross Stevens, MD
Long waits, outdated technology cost overruns, patients going home to die -- this is not change I can believe in.
Let's hope the US health system never gets to this point!
