Deja Vu - NZ Health System

[M3_Power 636]

https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12099111

Read the above article today and it gave me a sense of deja vu with what has been happening with my family.

We saw 5 different GPs for my son who all flogged us off as crazy parents before I self diagnosed him after reading countless number of medical journals and articles (luckily for me I had friends in the medical community that could access Doctors only material for me) and then finally an overseas diagnose we were able to obtain via video link and subsequent travel overseas for a specialist to see him. If we waited around for either private or public system we’d not even get an appointment for a good 6 months+ for a paediatric neurologist.

I have come to the conclusion that the NZ healthcare system is beyond broken, the GPs are undertrained, lack the desire and drive to dig deeper with patient concerns. 

My suggestion to all those out there seeking medical help - google the hell out of it and keep querying the “professionals” - not everyone can know everything even with a decade of medical training. Arm yourself with knowledge and don’t take one diagnosis at face value. Always be skeptical and follow your instincts. If a doctor tell you to stop googling, find another. 

 

Rant over!

[Young Thrash Driver 1020]

NZ has a publicly funded medical care system, not a health care system. An important distinction... Agree with the rest. Good on you for persevering, and all the best with what lies ahead.

[Jacko 2156]

Totally agree, its a farce. Dont get me wrong there are some good doctors, but damn there are a lot of hacks out there who get pumped out of the machine...

After an absolute hack (he was googling anatomy sh*t in front of me) twice misdiagnosed my broken ankle as a sprain, sent me back to work with instructions to take it easy on it. I refused to pay the bill, after walking around in pain for a week as it was just a sprain.. I went to a different surgery who instantly stuck my leg in an MRI and discovered my talar dome had a crack in it.. (2 months in a cast, 2 more months of light duties...) If I hadnt got a 2nd (3rd?) opinion I wouldve kept on walking around on a broken ankle and then wouldve had to have corrective surgery to stick all the bits back in the right places. 

Some of them are just there to dish out panadols and get paid 6 figures for it, and you have no idea which one knows what they are talking about, and which doesn't ? 

 

Edited August 1, 2018 by Jacko

[Driftit 2078]

Trust me.  The system is far far far better than the system here in the US.
I have never seen the same "GP" twice in 3 years.  Though I have tried to each time.  I have had to go to the doctor for very little yet my insurance states I have spent $15,000USD.
They hate to give you straight answers.  If they are wrong they get sued.
They send you in this big circle among "Specialists" which feels more like an organized scam than anything else.  Each of these will re-do the same tests as to squeeze every cent out of your insurance.

Everyone here self diagnoses.  In a way you have to or the doctors will head off in a direction, then stick to it so as not to admit liability to the f**k up.
But you must also be very very careful with this as they may just agree with your diagnoses to make things easier and more profitable.

If you don't have insurance and get sick.  You are screwed.  If you owe them money.  They will put you on the street.
Do not travel here without insurance.

The public system might be slow.  But at least it is there for everyone.

Edited August 1, 2018 by Driftit

[gjm 3258]

The NZ health system (a term I'm using to encompass medical care and all other aspects) has been run down over the last 10 years or so. It's a monster which is growing and while I thoroughly disagree, National's unsaid policy of promoting private health care is a model which could work in NZ. We have significant immigration, and many of those people do have significant health issues. (Ask me how I'm getting on with moving my brother here... ? )

This adds up to an unsustainable (current) health care model. More people requiring care, but not so much expansion in the funding available (and I'm not talking about government cuts - the money just does not exist) means a lowering in quality is we are to continue the availability.

National did run the health care system down. Sure, they kept throwing money at it, but that money came with caveats requiring it to be spent in specific areas. This meant the foundation of the system crumbled, while some aspects received a gilt edge.

Too much money is paid to very senior people in the health service. Not enough (proportionally, or any other way) gets to the lower echelons. Many DHBs are now dependent on volunteers to be able to maintain any semblance of community service. 'Crown Jewel' projects look great and may provide benefit to a small area, but suck funding from where it is actually, desperately, needed.

We've been lucky. Our (so far) rural area has a very good Healthcare system. However, we have seen timeframes blow out here too - in 3 years, we have gone from being in the fortunate position of being able to see a Doctor same or next day, to possibly being able to get an appointment in a week. MASSIVE residential development has been approved by the District Council and is underway, but plans for the supporting infrastructure are still in the very earliest stages. It's going to get a lot worse before it gets better... If it gets better.

The same is true on a NZ-wide scale. Labour will try to throw money at health, National will shout about waste. If Labour get in at the next election, we may start to see some improvements in healthcare, but possibly at the expense of other areas of national (small 'n') importance.

NZ is a small country in terms of population, with a widespread demographic and a significant self-imposed resident responsibility overhead. There aren't enough people in NZ to supply the taxation needed to maintain the level of services we have hitherto enjoyed... At least, not without fundamental changes.

Compare with Norway. 40% greater land area with similar geographic and residential dispersion issues, but less than 10% more people. They've made things work, but their way of government is very, very different. Sadly, NZ is probably suffering as a result of British influence and the 'old Empire' way of doing things. We need a massive shake-up.

None of that helps Tom. Damn, I feel for you, and sincerely hope you're now on a good path.

[Neal 544]

I find in Wellington the service to be very good to excellent. It could be worth moving yourself and family down here. It’s not.too large to get bounced around the various group but seems to have critical mass in terms of specialists. My daughter has been a frequent flyer of the system and we’ve done well with the right level of attention.

Had similar experience with elderly mother over the last couple of months which went from very serious , bed ridden to back home and living normally.

with my wife, she is here today due to the quick action of hospital staff.

Even with myself after having chest pains. From doctors through to hospital specialists.

so if you get continued run around in Auckland. See if you can find a specialist in Wellington and consider the move. ( big decisions, but your already making these)

Ethierway, hope you find the right people to help with your son in what are obviously stressful times.

[_ethrty-Andy_ 2132]

The NZ Health system does not have a funding problem, it has a spending problem. There is no need for 22 different DHBs each with thier own entirely seperate systems such as procurement, asset management, management structures, etc. There are also far to many funded NGOs that have no accountability of returns back into the community that pays for them. The funding, which has increased every year for decades under both National and Labour, never gets to the front line where it is needed, and thats what causes the illusion people have that it is underfunded. another example is your local private practice is paid something like $80 every year for every single one of thier patients registered with them. This is not to subsidise services that patients recieve (such as gp fees), that is funded seperately and on top.

There is no point throwing good money after bad in a broken system.

[Allanw 1071]

3 hours ago, _ethrty-Andy_ said:

The NZ Health system does not have a funding problem, it has a spending problem.

I see it every day.

[gjm 3258]

4 hours ago, _ethrty-Andy_ said:

The NZ Health system does not have a funding problem, it has a spending problem. There is no need for 22 different DHBs each with thier own entirely seperate systems such as procurement, asset management, management structures, etc. There are also far to many funded NGOs that have no accountability of returns back into the community that pays for them. The funding, which has increased every year for decades under both National and Labour, never gets to the front line where it is needed, and thats what causes the illusion people have that it is underfunded. another example is your local private practice is paid something like $80 every year for every single one of thier patients registered with them. This is not to subsidise services that patients recieve (such as gp fees), that is funded seperately and on top.

There is no point throwing good money after bad in a broken system.

There's a lot of waste in healthcare. One of the things I worked on while working at a DHB was reducing that waste. We were very successful... Sadly, not sufficiently so to have me keep my job.

There's a lot of waste in many areas of publicly-funded NZ. It's perhaps another example of following the UK, only 40-50 years later. The UK had huge government departments across all areas, the majority of which are now a fraction of their former size.

Getting the money to (be spent) where it is needed is certainly a major issue. Too many comfy chairs, nice boardroom tables, flash cars and high salaries (got to attract the best people) and so on, and not enough nurses, policemen and similar.

[hotwire 352]

6 hours ago, _ethrty-Andy_ said:

The NZ Health system does not have a funding problem, it has a spending problem. There is no need for 22 different DHBs each with thier own entirely seperate systems such as procurement, asset management, management structures, etc. There are also far to many funded NGOs that have no accountability of returns back into the community that pays for them. The funding, which has increased every year for decades under both National and Labour, never gets to the front line where it is needed, and thats what causes the illusion people have that it is underfunded. another example is your local private practice is paid something like $80 every year for every single one of thier patients registered with them. This is not to subsidise services that patients recieve (such as gp fees), that is funded seperately and on top.

There is no point throwing good money after bad in a broken system.

On the nail Andy. I've been spouting that for years!

[Olaf 3317]

On 8/2/2018 at 9:46 AM, gjm said:

The NZ health system (a term I'm using to encompass medical care and all other aspects) has been run down over the last 10 years or so. It's a monster which is growing and while I thoroughly disagree, National's unsaid policy of promoting private health care is a model which could work in NZ. We have significant immigration, and many of those people do have significant health issues. (Ask me how I'm getting on with moving my brother here... ? )

I have to challenge you on your populist Labour viewpoint here, Graham!

The charge that the NZ Health system has been run down over the past ten years presupposes it was in a good state to start with.  It was not.  Successive governments, regardless of branding, party, or resident health minister, have under-funded, and perpetuated mismanagement in the heath sector for decades  There have been large numbers of missed opportunities for betterment since the 90's and even before.

Any government will tell you retrospectively that they did the best they could at the time, and you can be sure they did.  If you had the opportunity to read the cabinet papers, and follow the decision making trail and Governance, I'm sure it would all read well.  You can be sure that our elected officials truly did what they thought best, within the constraints at the time.  The retrospective view always gives greater clarity, and is clouded if you don your blue-blocker sunglasses.  

It would be significantly healthier (pun intended) to acknowledge it's all a bit broken, and look to the government of the day (today)to put in changes that will truly make a difference.  It's futile blaming one side or the other; these things were decided by our government of each time... the consistent thread.  The cost to do this?  I'm sure it's a number so big that the budget would need significant rebalancing, and a great deal of courage.  As much as our system is seen as broken, it's a lot better than some of the other countries I've visited.  NHS excepted; my limited view is that the NHS works pretty well.

I certainly agree that the massive number of semi-autonomous DHBs in NZ is a total and complete waste of resources.

Perhaps someone could code up an online game called Fantasy Niuzillund Government... a bit like a cross between Championship Manager, The Sims, World of Tanks, and SupermarioKart, only instead governing NZ Inc (or use the NZ Collective skin, if you prefer)... one could trial radical healthcare restructures (note I avoided reform), and find the funding to make it stick, all the while managing the flow-on effects of short-changing other areas of the economy.  It'd be a hit!  

Cheers

[NZ BMW 368]

You need to find a good GP you can trust and have health insurance. I had cancer a couple of years ago and was referred to a top specialist very quickly and I honestly think that either saved my life or at the very least made my recovery much quicker and easier.

it was certainly a wake up call for me as if never really given what my exact coverage was much thought and always assumed that all doctors were created equal. 

Another one for people to check on their health insurance is to make sure it covered non-Pharmac drugs. Pharmac is a great system but it can’t find everything people may need.  

The more I see of health and the like, the more I think it’s like any other profession, with good and bad and most somewhere in between. 

[Karter16 407]

I full agree with your advice @M3_Power it’s  so important to keep pressing, especially if you feel that you’re not being taken seriously. 

With my son we were fortunate that he presented with some very clear symptoms that meant the escalation path was clear (weird to be using the word “fortunate” to describe that experience). 12 hours later he was under the Gastro team at Starship, who have been absolutely incredible. The nurses and doctors at Starship are fantastic and have supported us through long months of admissions. 

Its an absolutely horrible experience when your child is sick with a disease/condition and there’s really very little you can do to make it better, and I can’t imagine what it must be like to be fighting to be taken seriously at the same time...

I wish you and your family all the best in the journey ahead. It’s a very hard road that, despite best intentions, people can’t fully appreciate if they haven’t travelled a similar path... 

[zero 1162]

On 8/2/2018 at 9:46 AM, gjm said:

National did run the health care system down.

A common myth, but here are the facts;

 

Between 2008 and Budget 2017, the health budget increased by $4.85 billion a year from $11.92 billion to $16.77 billion – a 40.7% increase.

 

Also front line staff over the same time frame was increased by a large margin;

Population growth 8%

38% more doctors

25% more nurses

45% more senior doctors

45% more senior nurses

 

https://www.health.govt.nz/publication/health-workforce-new-zealand-annual-report-minister-health-1-july-2015-30-june-2016

[gjm 3258]

I don't dispute the increases in funding - it's how it was presented that caused some problems.

My perspective is slewed by the role I had and the specific DHB I worked at - they certainly did not see a 'real terms' increase in funding. The population growth in the area, and the demographic of the population meant that cuts of around $30m per year were needed to continue providing the same level of service.
Of course, some of that could easily have come from paying senior management a bit less, and not being as extravagant with some areas of spending.

In 2016/7, they sold a significant piece of land which had been earmarked for services expansion. This had to be done in order to ensure they didn't go into the red.

In 2017/8 they have had to find $45m in cuts in order to stay in the black.

And, of course, the problems could easily go back much further than just the recent National tenure - I lack the personal involvement to comment on that.

[kwhelan 241]

part of it is just technology, back in 2008 they may have spent $x  on a mri scanner for example and used it for x things, now they all have and people expect immediate access to ever more expensive equipment with ever more retraining of staff and they test and look at at far more things so the usage is way higher, Friend was recently scanned at 9pm on a sunday where they used to be all booked 8-5 mon to fri

same with all the new expensive drugs for cancer, etc there are far more treatments/cures available which also eat into the running costs, not saying its fair or right but the ability to actually fix so many more ills does cost a lot more

what gets me is how screwed pharmac is when buying our drugs, saw doco on a drug that cost 60k here was $1 in India purely because they would synthesis their own copy so they just sold it to them cheap as any money was better than none. The drug had payed its development costs back 3fold already and they were still reaming us down under

[gjm 3258]

13 hours ago, kwhelan said:

part of it is just technology, back in 2008 they may have spent $x  on a mri scanner for example and used it for x things, now they all have and people expect immediate access to ever more expensive equipment with ever more retraining of staff and they test and look at at far more things so the usage is way higher, Friend was recently scanned at 9pm on a sunday where they used to be all booked 8-5 mon to fri

same with all the new expensive drugs for cancer, etc there are far more treatments/cures available which also eat into the running costs, not saying its fair or right but the ability to actually fix so many more ills does cost a lot more

what gets me is how screwed pharmac is when buying our drugs, saw doco on a drug that cost 60k here was $1 in India purely because they would synthesis their own copy so they just sold it to them cheap as any money was better than none. The drug had payed its development costs back 3fold already and they were still reaming us down under

Excellent point. Technology has moved on and far more can be done. Because it can be done, it is expected to be done. I laud and praise the innovation of out of hours consulting too - radiography, blood tests, and scans of many sorts are now available for far more hours of the day. This does, of course, rack up more $$$ in availability of equipment, staff, maintenance and so on.

(I'm not getting started on Pharmac... Grrr...)

Much of the issue has been a combination of factors. Throwing money at a problem doesn't always work - sensible use of the money is what is needed, and that is down to the multiple DHBs. The DHBs need to work together, and (in the main) they don't. The Auckland area has something called the 'Northern Region' comprising of DHBs from Northland, Waitemata, Auckland, and Counties Manukau. There's lip service to working together, but the truth is that there is no integrated service provision, and there is a huge amount of back-and-forth budgetary cross-charging. Some areas do work together, but many of these seem to be on the admin and non-patient side.

Then there is the issue of patient records. Each DHB is responsible for it's own patient records, records management, records management systems and staff - there is no central repository or even records access, no records correlation, and no access to records held by another DHB. If you live in Auckland and break a leg skiing in Queenstown, your records will not be available to the staff treating you. Allergic reaction to Voltarol (as my wife has)? You'd better now this and be conscious to tell the medical staff on hand. (OK - they'll not use Voltarol, but you get the idea.)

What is worse is the complete lack of effort (on the part of the DHBs) to change this. In the Wanganui/Manawatu area, 3 new, different, patient records systems have been implemented in the last 2 years. (There's been prior discussion about PHOs...) There's no forethought, no planning, and consequent huge waste of money and resource.

I have the hugest respect for doctors, nurses and other medical professionals. I understand some of what they do and go through. I understand their complaints about pay, too... It's not so long ago that teachers, nurses and politicians were on a comparable level of pay. Not any more.

[kwhelan 241]

discovered this for myself when my son after months of visits etc locally was referred to starship. Upon getting there I had to explain the whole thing again, was just gobsmacked, I asked them to please get his records sent and to their credit they did, but wow, the public need to be told of these glaringly stupid systems

my old man retired early from his sole optometry practise because he just couldn't afford all the fancy gear they were expecting them to buy with like 10 yrs left of him working.which is why they all work together now in shared practises to share costs, like dentists

people moan about the costs but if you had any idea on how much those machines are costing and they go out of phase at the drop of a hat with any new feature, and with how much they have to spend on continuing their training with conferences all over the world , again single practise you have to shut the doors or pay a locum. you'd start to have some sympathy

 

[M3AN 4016]

Early on in my career, in the 90's I had some responsibility in the creation of the NHI. That was meant to fix so many of these problems and 20 years on? Not so much.

But, individual exceptions aside, we are blessed with our public health system. In comparison to many other developed countries, even OECD countries we do pretty well. Could it be better? Of course.