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| Cape Reinga Lighthouse |
Since arrival in New Zealand, I have been trying to surmise what is different about providing primary and emergency health care to New Zealand residents as opposed to Americans. No, the anatomy is not different, or at least I have not found the usual orifices in unusual places in the Southern Hemisphere. As I go through my daily list of 27 patients, I realize at the end of the day that despite the same medical challenges, something is different about the attitude of the New Zealand patients approach to their medical care.
Talking with colleagues in the US before leaving for NZ, I did receive a few trite answers about what might be different in patient care, but I wanted to experience it myself. Now that we have been here into the new year, it is time to put my own answer into writing. So how does a medical system that spends one-half to two-thirds less per capita, based on gross domestic product statistics compared to the United States, obtain things like lower infant mortality, longer life expectancy, and better access to care? How does a health care system where there are definitely fewer bells and whistles (and fewer grand piano players in the hospital entry foyer, oops, there isn't really an entry foyer either) outrank the USA on a number of desirable health outcome statistics?
The summary I was looking for was found not in the exam rooms of Broadway Health or Bay of Islands Hospital, but in the sage advice of a holiday house owner in Ahipara, the town at the beginning of Ninety Mile Beach. We, (Kim, the kids, and Karen and Tracy, two of Kim's classmates from physiotherapy school in Holland) had stopped overnight in Ahipara on our triangular tour of Northland from the Hokianga Harbor, to Cape Reinga and back to Kerikeri. Paul Steele (check out
www.holidayhouses.co.nz/properties/1979.asp) the owner of the beach front home at which we stayed, and a retired dentist from Wellington, took me aside as we were preparing to start our drive from Ahipara to the Cape.
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Cape Marie Van Diemen
Immediately west of Cape Reinga |
Paul had sized up our situation. Americans for sure by our accent (he even introduced us to his neighbor, a former resident of Sun Valley, ID. Idaho is a small state, but didn't know him.). Middle aged bloke traveling with three beautiful women and two children (bloke's a bit crazy?).
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| Tracy, Kim and Karen |
Automobile suitable for some Northland locals and a beach run (check out the pictures of our wheels known as "Beastie Babe" and the trailer "Beastie's Behind"). Seeing that we met all the requirements he was ready to give us his advice for travel.
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| Beastie Babe and Beastie's Behind at the end of Te Paki Stream and the beginning of Ninety Mile Beach |
"First, I wouldn't recommend what you are planning on doing." (Wait, we had not even discussed what we were planning on doing, other than vague plans for driving the tar sealed road safely up to the Cape and back.) "I would recommend just going into Kaitia and jumping on one of the bus tours." (Bus tour, our ignorance. We did not even investigate a bus tour option). Then he showed me the answer I had been looking for about the joy in life and blunt approach to their health care that I had appreciated from so many patients. Paul, with a sudden sparkle in his eye and a devilish grin, unfolded a map in front of me and said, "I would drive up the main road to the Cape, then when you get back to TePaki Stream, put that car in 4 wheel drive and gun it down the center of the stream. Maybe take a look around the first corner on foot before you go in, but otherwise don't stop driving hard until you get to the beach. If you bog down a bit, just gun it. I have checked the tides for you and you should be all good. Otherwise, just don't drive too close to the ocean and too close to the sides of the stream, where you can end up in a soft sand hole. You will come out alright at Waipapakauri Road."
Once we made our drive on the tar sealed road all the way to the Cape, with a stop at the Kauri Kingdom(spectacular kauri tree woodwork) and a brief test drive of Beastie on the white sands or Rarawa (Jetson's Astro pronounced that one) Beach we made our way back to Te Paki Stream Road.
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| Rarawa Beach. Yes we had most of it to ourselves! |
As Joel and McKeely tried some sand boarding on the dunes above TePaki, I walked around the first corner and had a look to the beach (couldn't see it as there were alot more corners in the stream before Ninety Mile Beach). Suddenly Paul's words, my experience with patient expectations in two different countries, and the metaphor of an equitable health care system all came together.
I stood in shallow stream water on solidly packed platform of sand that shifted only slowly and slightly with my steps. New Zealand people needing medical care, like much of the rest of the sane (not US) industrialized world, start with a secure platform of single party payer (usually government) health care. Compare that to the current US system which would look more like a boulder strewn river. Great if you can cling to one of those insurance rocks (did you see that Big Blue Boulder), but the water is deep and fast moving (drown your family in bankruptcy) if you lose your job or are denied insurance. If you can hold your breath long enough in the US system (lose all your finances first), you may get caught by the bottom level small rocks of Medicaid. The smooth secure platform of guaranteed health care for all, allows New Zealanders to have far less anxiety as a starting point about what their diagnosis may be when they arrive in need of medical care.
The kids had finished sand boarding when I returned, so we loaded back into Beastie. Continuing the metaphor, I would consider Beastie as the health care providers in New Zealand. Solid, reliable, a few dings, but utilitarian and dependable for everyones need. In the US, the providers probably win this part of the metaphor, so think of Beastie in the US as a full size Ford F-350 4X4 with all the upgrades to help you crash through the boulder strewn stream. Just like myself, and many of the other providers in New Zealand, as I discussed in my previous post, Beastie is an import! In the US though, even the best providers get caught drowning with you beneath the boulders of the bureaucracy of insurance boulders.
I started Beastie up, put her in 4-wheel drive and off we went. Like anyone with a medical condition, going around the first corner in the stream is a blind corner, and everyone inside of Beastie had a little anxiety. In the US, our recent health care reform debate convinced us of all kinds of fears around that first corner in a diagnosis. A single party payer system will cause us to "lose your choice and independence", or "death squads lurking", or "government cronies will decide the care you receive". Beastie rolled into the stream with the sand firmly supporting us, and I added a little speed for Beastie to get around the first corner. Instead of additional dangers, we found exactly what people living with a single party payer health system in New Zealand have found: wide open pathways to maintaining our health (the stream widened through the sand dunes), independent choices ( the stream split around soft sand islands in the stream, and we could chose either side), and security (we made it safely to the wide driving path on Ninety Mile Beach!).
That is what I have found with patient expectations here in New Zealand. People have independence with confidence that the system will provide for them when in need. They understand that if their diagnosis warrants it, they will receive the care they need immediately, and wait with appropriate patience if their diagnosis is less critical or life altering. They understand their choice that they can buy up to additional private insurance which gives them access to faster, but not better medical care. They come in with the security that whatever the diagnosis, their family will not be devastated by an additional financial ruin. They know that if something with their care goes wrong they will have financial support (ACC and WINZ programs). They often question me how our country can have a system that seems so unfair from their point of view. Peaks and valleys they refer to it. Hence the boulders in the stream analogy.
Our traveling group proved that such a system of single party payer health care could work from coast to coast in the US. One-quarter the way down the actual 55 miles of driving Ninety Mile Beach, Karen, who is from Long Island in New York City took over Beasties wheel. She safely guided Beastie the rest of the way to the Lake Ngatu turnoff to return to the tar sealed road. From Oregon to New York state we enjoyed the drive on the solid sand beneath us.
As we made our way back to the main road, we all had a sparkle in our eye and a grin on our face, much like Paul's. Thrilled by the beautiful scenery along Ninety Mile Beach and joy in overcoming a fear unknown. Maybe we should approach our solution to the health care problem in much the same way. Overcome our fears of a single party payer health care system. Wouldn't it be nice to not fear financial devastation anytime you need medical care? Come on, jump on board Beastie, and we will go for a ride!
