As Americans, especially as our country has been engaged in so much debate about healthcare reform over the last few years, we’ve all heard stories about other countries’ health systems and how terrible, wonderful, dysfunctional or compassionate they are. It’s difficult to find reliable information about how another system actually functions for the patients and medical staff involved.
Since Matt started his job as an emergency physician in New Zealand about six months ago, I’ve gotten to hear a lot from him and from his colleagues about working in the New Zealand health system. What factors do they say stand out?
- Healthcare is free for almost everyone. All New Zealanders are covered by the national healthcare system. This means primary care is nearly universal and people generally get the routine care they need from their GP. Most patients come to the emergency department because they have an emergency, not because they don’t have any other access to care.
- Doctors and nurses come here from across the globe. Matt works alongside many New Zealanders but also with colleagues from North America, Europe, Asia and the Middle East. I was worried that living and working in a small town would mean we’d be the only ones around who didn’t grow up nearby. That hasn’t been the case at all.
- Patients don’t always have quick access to specialists or diagnostic tests. For years, Matt worked the night shift in a busy ER that was staffed around the clock with technicians to conduct any diagnostic test a patient needed. He could call specialists who would fit in a patient on Monday if necessary. It was a real adjustment for him to move to a system where diagnostic tests often wait until morning and it can take weeks or months to schedule consultations with specialists. He and his colleagues are nearly always able to speak with a specialist immediately, though, and get advice on initiating treatment right away until that appointment is available.
- The professional environment is collegial and respectful. Since we’ve moved to New Zealand, I’ve never heard Matt mention a colleague who was volatile, disrespectful or even unhelpful. The work-life balance thing is real: doctors here are generally not overworked to the point of becoming unhappy or unpleasant to work with.
- Doctors aren’t working with a constant fear of lawsuits. The malpractice environment for doctors is totally different in New Zealand. While professional standards and accountability seem quite rigorous, the threat of frivolous lawsuits is almost zero. From what I can see, this extends outside of healthcare -- the culture of litigation and the adversarial interactions that go with it just don’t exist here as they do in the U.S.
- Maori cultural beliefs are integrated into the fabric of the system. From a space in the hospital where extended family can gather to the simple training that Matt received as part of his orientation, there’s been a conscious effort to shape the healthcare system here in a way that respects and integrates Maori cultural practices and values. This is a complex dynamic that I’m sure will continue to evolve. Doctors from overseas say the personal and professional lessons it provides are tremendous.
- Drugs have different names here, and not every drug is available on the national formulary. New Zealand has a national formulary for drugs, which includes each type of medication but not as many options in each class as in the U.S. Those drugs go by names that are similar to the British system rather than the American one. Matt was pretty worried about this before starting his job here, but says it turned out to be a non-issue. His actual words were, “It’s like a foreign language for the first week, then it’s fine.” The pharmacist at his hospital even installed a program on his computer to help with that first week.
- There’s a network of medical staff in place to visit patients at home after they leave the hospital. If Matt sees a patient who has trouble walking or taking her medications, he can work with the hospital to arrange follow-up care at home without any cost to the patient. New Zealand has a network of visiting nurses and healthcare assistants who drop by patients’ homes to dress wounds, administer medicine and help with changing, showering, tidying the house -- the basics of daily life. When one of my elderly neighbors recently returned from a short stay at the hospital, I found her at home cushioning her injured leg on a comfortable chair that the hospital had provided so she could get the rest she needed to recover.
- Patients are appreciative. This is a subjective and intangible one, but something that I’ve heard Matt and his colleagues mention again and again: patients here openly appreciate the care they get from their doctors and nurses. People seem to have a realistic expectation of what is available and feasible within the health system and appreciate the effort that the medical staff makes. I’ve heard doctors nearing retirement say that it reminds them why they got into medicine in the first place.
From my point of view outside the healthcare system, I see one more small but remarkable difference: I run into Matt’s co-workers on the waterfront trail or see them catching up with friends at a coffee shop in town. The work schedule for doctors here leaves time to take care of your own well-being, too.
Up next: putting that free time to good use and exploring New Zealand!
Tara Kennon is an American writer living and working in New Zealand’s beautiful Coromandel peninsula. While she interviews macadamia farmers and attempts to learn proper British spelling, her partner Matt is learning the ins and outs of New Zealand’s healthcare system as an emergency physician in a regional rural hospital. This series shares an on-the-ground perspective of their journey from Chicago to this gorgeous little corner of the Southern Hemisphere.