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Regardless of the structural framework of any nation's healthcare system, a critical measure of its success will depend upon the aligned incentives and objectives of its key constituents.
The Academy for International Health Studies recently traveled to Auckland, New Zealand, to study this country's system of universal coverage. Rather than a patient or provider-centric approach to healthcare, New Zealanders have embraced a population-focused system. Culturally, they accept the restrictions mandated by limited financial resources and strive to achieve admirable results at a reasonable cost. (New Zealand spends approximately 8% of GDP on healthcare on behalf of its 4 million inhabitants; approximately half that of the United States, achieving a slightly longer life expectancy.)
Throughout the system, the Ministry of Health, the public hospitals, specialists, primary care physicians, and the District Health Boards, which function as regional staff-model HMOs, all accept and even embrace the obligation to care for all.
Not without its tensions, stretched budget constraints invariably result in flare-ups. During the Academy's visit to Auckland, unionized GPs were protesting for higher reimbursement, rates while laboratory workers were on strike. The consensus driving the overall system, however, remained unchanged. Even the acting director of Pharmac, New Zealand's pharmaceutical regulatory and purchasing agency, said that if offered more funding by the Ministry of Health, Pharmac would probably only waste it.
In the public system, no one in New Zealand will ever see a waiting list greater than one year. If a general practitioner suspects that a patient will not be able to receive treatment such as a hip replacement within 12 months, the patient is not placed on any list. If the patient's condition is not urgent enough to demand treatment within one year, he or she is told come back later.
One phenomenon contributing to the efficiency of this island nation's health system is the elimination of any substantive role for lawyers. New Zealand's no-fault legislative framework insured by the Accident Compensation Corp. (ACC) covers medical costs and lost wages for all injuries, including automobile, work-related and medical. Malpractice liability is therefore virtually non-existent. If queues in the public system grow too long, the ACC purchases care from the private system to avoid paying lost wages to the injured party and accelerate his or her return to work.
The same mindset applies to information technology. Ninety-nine percent of general practitioners employ automated records, allowing for the incorporation of real-time applications of evidenced-based protocols. An Auckland-based Internet service provider assures the confidentiality of electronic clinical information. All New Zealanders also have a unique inpatient identifier. A selfless focus for population health also has facilitated the resolution of issues related to intellectual property rights, permitting the discussion among software developers as to how best to assemble an integrated electronic medical record.
MHE Editorial Advisor Bruce Pollack is president of the Academy for International Health Studies.