New Zealand – Increasing the Pace of Integration 1
My first stop was Wellington, New Zealand. You must excuse me for being drawn to the allegorical given this is the home of “Middle Earth”. On my first evening in the country I dined at “The GP” an upmarket, pub style restaurant in the heart of the capital. Its beautiful, french inspired three levels are now home to some very fine food and wonderful wine. In 1902 it was built to house the resident general practitioner, his family and his practice. How times have changed! Sole practitioners are now a dying breed and even they rarely practice from their own homes, no matter how grand. To my eyes, this home was emblematic of the shift in care from isolated medical provision to a world where care is delivered by teams focused on patient needs and delivering as close to the patient as possible. This is certainly where New Zealand is headed.
My second observation about New Zealand is that we humans can be our own “mouse models”. The Kiwis are comparative late comers to subsidised general practice care. Beginning in the early 2000’s New Zealand started to fund access to care for the over 65’s, gradually moving to cover the entire population. In their capitation model, most patients still pay a significant co-payment (for most adults around the $40 mark). What is surprising is the level of satisfaction this solution has brought. The lesson is that if you start your health experiment from a different base you create different expectations. In addition, the recency of moves towards subsidised care are such that patients still remember the days of paying the full cost of a consultation. They are grateful for having to pay much less now and show a deeper appreciation of what care really costs.
In our 30+ year experiment with Medicare, we began promising free medical care for all in exchange for a 1.5% Medicare Levy. A whole generation has grown up with bulk billing and the remainder have now come to see it as their right to access a bulk billed provider. This led to the recent debate which overturned the government’s commitment to introducing a very moderate $7 co-payment. The Kiwis were staggered that this was capped at $70 per year with exclusions for chronic disease and healthcare card holders. Just goes to show that even human mice can be conditioned and have short memories!
Tracey Johnson, General Manager, Inala Primary Care