Kat Fankhauser

In New Zealand, government subsidies make it possible for citizens to receive free public healthcare. However, if a person isn’t a resident treatment costs do apply. There are at least 40 public hospitals scattered around the country on both islands. The process of seeing a specialist begins with a GP referral. Most specialists are available through the public health sector and a majority also work privately.

Going through the public health system means going on a waiting list depending on the type of surgery required and the seriousness of the disease or condition. Private hospitals tend to have shorter waiting lists for admittance and surgical procedures. Private healthcare insurance is an option that some citizens take. Accidents and emergency incidents can be treated for free in hospital emergency departments. When a person is injured in an accident they can apply for medical and recovery costs via the Accident Compensation Corporation (ACC) scheme. Unlike the USA, citizens generally don’t sue for compensation which is why ACC exists. 
 
According to a 2012 study conducted by a US-based foundation, called the Commonwealth Fund, New Zealand spends the second lowest amount of money on health care per person. Michael Daly summarizes that, “One factor helping keep the country’s healthcare costs down was that it had the smallest elderly population in the study, with 12.8% of people over 65, while the US had the second lowest at 13%. On the other hand, this country had the second highest proportion of people classed by the study as obese at 26.5%, lower only than the US which was put at 33.8%.” (Daly 2012)

Another study conducted by ID Medical ranked New Zealand 19th out of 24 countries. This study shows that  New Zealand’s healthcare system is as good as the United Kingdom, with that been said, they both fall behind the likes of Japan, France, Austria who made the top five. Australia’s healthcare ranked higher than New Zealand. As the USA has no public or universal healthcare system they were notably absent from the studies.

    New Zealand governments have experimented with different schemes albeit the fundamental principal of what the system should look like, always comes down to patient perspective. Equity, access, integration and prevention are the underlying goals as they make sense to patients and professionals. Even though the world rates NZ’s healthcare system high, the actual statistics in the country demonstrate that the indigenous citizens, Maori, tend to receive bad health care compared to other New Zealanders. Up until recently there has been no government inquiry into why there is such inequality in the treatment of Maori patients. In March 2019 the NZ government announced the, “Wellness Budget,” which promises an investigation into the differences, and more money for areas such as mental health, suicide rates and other health issues that plague a high percentage of New Zealand citizens.

     In her book, Fixing Medical Prices: How Physicians Are Paid, Kiwi academic Miriam Laugesen, highlights that in the  US a committee of 30 members, has played a central role in determining the fee schedules for American doctors. Each transaction is known as a billing code therefore associated with a unit value. Medicare and private health insurers then convert these values into a dollar price. The US health system is dominated by private health insurers.  Because of the unfair distribution of unit values assigned by the committee, there is a reduction in general practitioners and a greater proportion of medical specialists, in the US compared to countries like New Zealand.  Another consequence that occurs is the amount of unnecessary MRI, CT scans and caesarean-section Americans have. According to Laugesen, “This focus on performing high-paying procedures leads to over­treatment and is also helping to fuel the US’s high health costs, which sit at $3 trillion, or about 17% of GDP. In ­comparison, New Zealand spends about 11% of GDP on health, and in the UK, it’s about 9%. However, despite spending less, both New Zealand and the UK have better health outcomes than the US, including a longer average life expectancy and fewer people with chronic conditions.” (Nicol 2017).

    In conclusion the US and New Zealand healthcare systems are a pole apart. In some areas they succeed, while in other areas there are inequalities.

“How Communication Factors In” by the Director

    The blog above discusses a selection of differences between healthcare in New Zealand and the United States. It’s essential to consider an international perspective on healthcare to better understand the strengths and weaknesses of the American healthcare system. The crux of this issue, especially in the US, is that hospital and healthcare policies vary, making treatment vary from setting to setting, situation to situation.
 
    But where does communication, or lack thereof, influence the delivery of unequal healthcare?
 
    It boils down to three words, “Know Your Rights.”
 
    As a patient in a hospital, clinic, or ambulatory outpatient setting, there are things that hospital staff must communicate to you, whether in print or verbally. Moreover, there are policies in place since the 1940s, which enlist and protect your rights to care.
 

1. The Hill Burton Act and Title VI of the Civil Rights Act of 1964. In 1946, prior to the Title VI of the Civil Rights Act of 1964, the Hill Burton Act was created. Congress passed a law that gave hospitals, nursing homes and other health care facilities grants and loans for much-needed reconstruction and modernization. Like the future 1964 Act, this Act prohibited discrimination on the basis of race, color, or national origin in any program or activity that receives Federal funds or other Federal financial assistance. This includes language access. So if a family came into a publicly-funded hospital and requested an language interpreter and the hospital refused to provide one for them due to time, staffing, or even budget cuts, the family has a right to pursue legal action against that hospital. The hospital is receiving public funds from the government and they must allocate a certain percentage of their revenue to specific services. In addition, the Hill Burton requires publicly-funded healthcare facilities to provide a reasonable volume of free care each year for those who cannot afford to pay.

     What settings count as “healthcare facilities?” Of course hospitals, but the following environments count, too:

• Extended care facilities

• Public assistance programs

• Nursing homes

• Adoption agencies

• Hospitals

• Day care centers

• Mental health centers

• Senior citizen centers

• Medicaid and Medicare

• Family health centers and clinics

• Alcohol and drug treatment centers

 
     Keep in mind, however, due to the Hill Burton Act’s rules about grants, separate but equal facilities in the same area were allowed until Simkins v. Cone in 1963. So even though hospitals were not allowed to discriminate, hospitals, and the healthcare delivered, was separate but equal until 1964 due to separate funding structures. The rights protected by the 1964 Act still stand, but the Hill Burton Act program stopped providing funds in 1997. Still, about 140 health care facilities nationwide are obligated to provide free or reduced-cost care (Health Resources Service Administration (HRSA), 2019).
 
     So what must healthcare facilities do to be in compliance with Title VI, today?

     According to FindLaw.com, in order to comply with Title VI, health care entities are required to perform the following actions:

• Provide free oral and written language assistance to patients who have limited English proficiency (LEP). The U.S. Supreme Court has held that discrimination against individuals with LEP is considered discrimination against national origin. Therefore, these individuals are entitled to equal access just as English speakers are entitled. This also includes giving patients notice that they have a right to these services.

• Provide free written and oral assistance to patients with other special communication needs such as those who need audio assistance, large print, or Braille.

• Post signs and materials in languages of the service area’s predominant cultural and ethnic groups. This includes making consent forms and other essential documents available in these languages.

 
     Since these rights are granted to you as soon as you become a patient, either via signing documentation, or by word of mouth, if you are later neglected, injured, or killed in a healthcare setting due to the failure of that facility providing you with needs and/or services you have rights to, you, or your family, also have a right to seek justice.