Health and Welfare
HOW HEALTH CARE IS ORGANISED
The New Zealand health system is made up of public, private and voluntary sectors which interact to provide and fund health care.
Department of Health
The Department is the principal adviser to the Minister of Health on health issues. It administers relevant legislation, funds programmes and ensures the provision of essential services. It collects and disseminates information, liaises and consults on health matters, monitors and reviews health programmes and is responsible for ensuring that its work is underpinned by a focus on the Government's desired health outcomes.
Regional Health Authorities
In July 1993 four Regional Health Authorities were established as independent Crown Agencies with their own Board of Directors.
The primary objective of Regional Health Authorities is to ensure that the population in their regions receives optimum value from the health and disability support services funding, entrusted to the Regional Health Authorities within the parameters of Government policy. The RHAs purchase health procedures by way of tendering for services and contracting with health care providers, i.e. hospitals (CHEs), rest homes, etc.
Other care providers
Health care provided by general practitioners is also partially funded from the public purse, as are referrals to specialists and laboratory diagnostic services. Dental care is provided free to dependent children under 18 years of age. Eighty per cent of the cost of Pharmaceuticals is met through public funding. A number of private hospital services are subsidised, and a range of private and voluntary organisations receive funding for services they are contracted to provide.
Accident compensation levies cover 4.2% of health care costs for services provided in the public and private sectors. The private sector provides a wide range of health care options. Forty-five per cent of the population has private health insurance, meeting 3.5% of the total cost of health care.
An active voluntary sector incorporates a wide range of organisations which provide care, support, health education and research. Health care is also provided informally by families and relatives, and this is recognised through the growing provision of home support services in the public and voluntary sectors.
General taxation funds an estimated 77% of the total costs of health care. This funding is primarily disbursed through the Department of Health, which distributes funds to area health boards, and a wide range of health professionals and organisations providing services to the public. It also includes funding for health-related expenditure through other government departments such as Social Welfare, Defence and Police.
Over recent years governments have introduced a number of measures to curb health spending, while maintaining services. Area health board funding, which makes up nearly 70% of the Department of Health's budget allocation, has come in for particular attention.
A population-based method is used to determine funding for the boards. It takes into account the age and gender of the population in each region, by adjusting for the expected resource use of each age/ gender group, derived from national levels. Special health needs are also considered, through calculations based on socio-economic factors.
In 1992 the Government expanded the ability of the boards to charge each other for cross-boundary service provision. From February 1992, the boards began receiving revenue from inpatient and outpatient user charges.
Service statements have been developed by the Department of Health, in consultation with health service providers. These are designed to provide guidance to the area health boards on the content and structure of services provided by each board. The statements provide a national perspective on the key elements comprising a service, as well as the policy and legislative parameters for each service. Each board will design and provide the services in accordance with its own strategic and financial planning processes. These may reflect their assessment of local needs and resource priorities.
NEW ZEALAND'S HEALTH & WELFARE SCHEME
The Department of Social Welfare, which reports to the Minister in charge of the department, exists to assist Government to achieve its goals in meeting the welfare needs of New Zealanders.
These social security goals fall broadly into three groups:
- To ensure that all the people of New Zealand receive an adequate income.
- To provide and deliver welfare services and support to the community.
- To allocate and deliver resources and support to community groups and organisations and enhance their ability to deliver Social Services.
The New Zealand Income Support Service provides for:
- National Superannuation
- Unemployment Benefit
- Domestic Purposes Benefit
- Invalids Benefit
- Sickness Benefit
- Widows Benefit.
The Social Security (Reciprocity with United Kingdom) Act 1983 provides for reciprocity in a comprehensive range of benefits. The general principle of the convention is that people migrating from one country to another will be taken into the social security scheme of the receiving country, and paid benefits under the laws and conditions applicable to other residents of that country (not the home country).
In essence, if you have lived for the last ten years in the country with the reciprocal agreement, you will be automatically entitled to receive income assistance. If you do not live in a country with a reciprocal agreement you will need to have lived in New Zealand for ten years before you qualify.
- Income Support Service
- International Affairs Office
- Free phone: 64 0800 552 002.
The benefit rates are approximately: Net NZ$
- single person living alone 225.55 pw
- single person sharing 208.20 pw
- married couple 347.00 pw
In 1987 the Labour Government decided, on the advice of the Minister of Finance, Roger Douglas, to discontinue tax incentives for personal insurance and superannuation savings. Prior to this, a person was allowed a tax rebate of NZ$1,400 on personal superannuation, and $1,200 on subsidised superannuation. The Government chose not to replace this with another scheme, and many people saw this as a disincentive to save.
The New Zealand Government is facing the same problem as many other countries, i.e. the increasing population of elderly people, which in turn places a big burden on the working population. The question now being asked is whether the New Zealand Government can continue to make superannuation payments indefinitely.
It is very obvious when you take the National Superannuation payment, and consider the cost of living, that some extra savings must be made in order to able to retire with some dignity. There are many superannuation and insurance companies operating in New Zealand, and it certainly pays to shop around for the best deals.
Given below are some of the better known financial consultants and superannuation schemes:
Money Concepts, 109 Molesworth Street, Thorndon, Wellington 6001. Tel: 64 4 473 0876. Website: www.moneyconcepts.co.nz
Money Concepts, 169 Princess Street, Dunedin 9001. Tel: 64 3 477 5660.
Tower Trust Ltd, Box 2949, Wellington. Tel: 64 4 495 0995. Website: www.towertrust.co.nz
Forsyth Barr Prater Willliams, Box 97, Auckland. Tel: 64 9 303 2473.
AMP, PO Box 1499, Wellington 6015. Tel: 64 4 384 6369. Tower Retirement Investment Ltd, PO Box 1086,
Christchurch 8015. Tel: 64 3 365 4065. Tower Retirement Investment Ltd, PO Box 742, Nelson 7016. Tel: 64 3 548 7025.
The reciprocal agreement applies for citizens of the United Kingdom and Australia, which means that should the situation arise you would receive unemployment benefit. Citizens of other countries need to have lived in New Zealand for 12 months before they become eligible. For further information contact Work and Income New Zealand, PO Box 12-136, Wellington. Tel: 64 4 916 3300. Fax: 64 4 918 9779. Website: www.winz.govt.nz.
Domestic purposes benefit
The domestic purposes benefit is paid to:
- a parent caring for children without the support of a partner
- a person caring for someone at home who would otherwise be hospitalised
- an older woman alone – only in some cases.
The amount the beneficiary receives depends on:
- whether they are married or have a partner
- number of children living with the recipient
- how much income they earn.
For further information contact Work and Income New Zealand, PO Box 12-136, Wellington. Tel: 64 4 913 0300. Fax: 64 4 918 9779. Website: www.winz.govt.nz.
This is for people who can't work and have had a drop in their earnings either because they are temporarily sick or injured, or because they are pregnant. The reciprocal agreement applies in this section also for Britain and Australia.
For further information contact Work and Income New Zealand, PO Box 12-136, Wellington. Tel: 64 4 916 3300. Fax: 64 4 918 9779. Website: www.winz.govt.nz.
Widow's and bereaved families benefit
The widow's benefit is paid to a woman whose husband or partner has died. The benefit helps those who have children to support or who have spent a number of years married or raising children – if the recipient does not have children, in order to qualify they must be over 50 years old. If the recipient has remarried then they are no longer entitled to receive this benefit.
For further information contact Work and Income New Zealand, PO Box 12-136, Wellington. Tel: 64 4 916 3300.
Fax: 64 4 918 9779. Website: www.winz.govt.nz.
HEALTH SERVICE CHARGES FOR THE PATIENT
Visiting the doctor
The cost of a visit to a doctor in New Zealand varies depending on the doctor and possibly the area where you live. If you are on a low income and qualify for a community services card, you will pay a subsidised rate. If you do not, the approximate costs are as follows:
- senior citizen $30.00
- adult $60.00
- child under 5 free
- child 5-18 $30.00
If you just require a repeat prescription, then the charge (without seeing the doctor) will be $6. On top of this you will have to pay the cost of the drugs prescribed; each pharmacy has its own charges, depending on the drugs needed.
Visiting the dentist
There is no free dental treatment in New Zealand, and the cost of keeping your pearly smile can be horrendous. The figures shown are approximate examples, as treatments can vary, and so can the dental costs. It certainly pays to check around first before making an appointment.
Some private health schemes do cover dental treatment, so it would pay to check around before taking out cover if this would be a priority for you.
For further information contact the Dental Council of New Zealand, PO Box 10-448 Wellington, New Zealand. Tel: 64 4 499 4820. Fax: 64 4 499 1668.
Your state of health
Public health care in New Zealand is undergoing several changes, timed it seems with Government mood swings. It was decided in 1991 that hospitals should be run as businesses (that means paying tax). Several smaller community hospitals were closed down.
Waiting lists exist for many operations, and for some lifethreatening situations, families have had to raise many thousands of dollars to send the patient overseas for treatment.
The benefits of private health schemes are quite obvious in such a situation. You then can have the special care you need without having to mortgage your home to get medical treatment. The schemes also pay a percentage of your visits to your doctor.
Medical insurance companies
These are a few medical insurance companies:
Medic Aid, 46 Smithfield Road, Wanganui 5001. Tel: 64 6 347 1895.
Southern Cross, PB 99-934, Newmarket, Auckland 1031. Tel: 64 9 356 0900. Website: www.southerncross.co.nz
Southern Cross, PO Box 27-145, Wellington. Tel: 64 4 384 4199. Fax: 64 4 385 0771. Website: www.southerncross.co.nz
Southern Cross, PO Box 1316, Dunedin 9015. Tel: 64 3 477 6365.
Southern Cross, PO Box 922. Ivercargill 9515. Tel: 64 3 218 3106.
Southern Cross, PO Box 1091, Hamilton 2015. Tel: 64 7 839 5108.
Aetna Health, PO Box 6772, Auckland. Tel: 64 9 302 8720.
AMP General Insurance, AMP Building, PO Box 1093, Wellington. Tel: 64 4 498 8000.
Typical costs of operations
Here are some typical costs for 'everyday' type surgery in a private hospital:
- Tonsils (child) $ 1,590
(adult) $ 1,795
- Varicose veins $ 2,170
- Knee replacement $12,520
- Ingrown toenails $ 710
- Mastectomy $ 1,930
- Cardiac bypass $21,445
- Hip replacement $ 11,585
- Hysterectomy $ 3,910
Reciprocal agreement exists for citizens of England, Scotland, Wales and Northern Ireland, as well as citizens of Australia to receive free hospital treatment for emergency cases. This of course does not cover a preknown medical state, where you would have to pay for treatment. Accidents are also covered in the A.I. Act under ACC (the Accident Compensation Corporation). For citizens of other countries where a reciprocal agreement is not in force, the costs can be large, e.g.:
Excluding GST (12.5%)
- Outpatient (flat rate) $188-$300
- Overnight stay (minimum) $457-$3,704
On top of this will be the cost of treatment you may require. Surgical costs can be from $3,700 per day for intensive and critical care. X-rays, blood tests, CT scans, operating costs and pharmacy costs are extra.
Eligibility for free treatment
- Those granted permanent residence or admitted as refugees by Immigration services.
- Cook, Nuie and Tokelau Islanders.
- Residents of Great Britain and Northern Ireland, including any premature births and complex maternity cases, but not including normal maternity care or those with a pre-existent condition.
- UK Royal Navy personnel.
- US Antarctic Expedition personnel.
- Those in possession of an extended work permit of two years or more. (The passport must be sighted for evidence of the permit.)
Not eligible for free treatment
- All other nationalities not mentioned previously, including citizens of the Commonwealth nations, Ireland, Japan, Fiji, Western Samoa, Tonga, New Caledonia, Tahiti, Kiribati and Vanuatu.
- NZ citizens or their dependants who have not themselves lived in NZ. Ordinarily, once a New Zealander, always a New Zealander, but those born to New Zealanders overseas must live in New Zealand to qualify.
- Those born in NZ or Australia, but now resident elsewhere (apart from NZ) or who have come here specifically for treatment.
- Fullbright scholars, except those from UK or Australia. Seamen from overseas ships. (Shipowner pays.)
- Those on temporary permits (i.e. student/work/visitor).
Work permits and visitor permits are normally issued for a maximum of one year only.
THE ACCIDENT COMPENSATION CORPORATION
We have a scheme here in New Zealand whereby everyone has $1.24 per $100 deducted from their earnings, and the employer also pays a proportion, i.e. from $1.18 to $5 per person per week depending on the type of work done; dangerous occupations will pay more.
In the event of an accident, the Accident Compensation Corporation pays for the treatment to the injured person; if that person is unable to work any more, then they are paid a percentage of their earnings up to a limit of around $86,000.
Some say that the scheme is good, but there have been many occasions when a person has been badly injured by, say, a car accident, and they are the innocent party. Under normal circumstances they could have sued that person, but Accident Compensation Corporation has taken away the right of a person to sue. So instead of a good lump sum payout, which might have paid for special equipment to help the injured person, the victim now has to be content with a weekly payment relative to the size of their earnings at the time of the accident subject to a maximum limit of approximately $86,000 per annum.
In 1990, just to give you an illustration, I was driving along a secondary road, and whilst waiting to turn right was hit from behind. The resulting damage was whiplash resulting in a permanent weakness to the right shoulder/neck area. I claimed Accident Compensation. After being examined by a specialist – 12 months after the accident – I was awarded $12,000. Since then the terms of Accident Compensation have been changed, and people can no longer receive lump sum payments.
The first health camp in New Zealand was organised by Dr Elizabeth Gunn in 1919. Dr Gunn was the school doctor for the Wanganui area; she believed that if delicate and undernourished children could be taught the basics of hygiene and nutrition and receive the benefit of rest and fresh air, many of their ailments would be cured. With the help of a local farmer, volunteer teachers and equipment hired from the army, Dr Gunn organised the camp at Turakina, near Wanganui. The camp was run along military lines with a bugle wake-up call in the morning, regimented eating and sleeping times, toothbrush drill, marching and flag saluting. After six weeks of camp-life the children flourished.
The success of Dr Gunn's health camps aroused public interest in the idea and by 1929 'sunshine camps', financed by private donations, were being run in several areas. 1929 also saw the first issue of health stamps by the Post Office with each stamp sold contributing one penny to the health camp fund. The first permanent camp was established at Otaki in 1932. By 1936 the movement was growing rapidly and a National Health Camp Federation was formed to oversee the burgeoning number of camps. In 1937 the King George V Memorial Fund raised 175,000 pounds sterling to establish permanent camps throughout the country.
The tradition of health camps that Dr Gunn established continues today. There are now seven permanent health camps at Whangarei, Pakuranga, Rotorua, Gisborne, Otaki, Christchurch and Roxburgh. Four to six-week camps are held for children aged five to 12 years. The children are usually referred by teachers or doctors.
Health camps today also help children with psychological or behavioural problems. As well as the games, schooling and health education that have always been part of the health camp regimen, children are now taught anger management, learning skills and life skills such as basic cooking and general personal hygiene. The Ministry of Education runs a special school in each camp where children with education problems can be given extra attention to develop positive attitudes towards schoolwork and learning. New Zealand Post continues to issue health stamps every spring, raising up to NZ$100,000 a year for health camps and child health generally.
QUESTIONS AND ANSWERS
Is alternative medicine available in New Zealand?
Yes, very definitely. There is a very strong interest in acupuncture, aromatherapy, chiropractors and reflexology. There are also experts on herbal remedies.
Is dental treatment covered by the Health Department?
Only for children who are still at school. Everyone else must pay. Private health insurance can cover this.
Do I have to pay for medical treatment if I have an accident?
No. This type of treatment, whether in the hospital or from a doctor, is covered by Accident Compensation.