So given this is our hospital and we work in the most isolated part of New Zealand which has a very different medical system than most other parts,, maybe my observations should be taken in that context. We work for the West Coast District Health Board, one of many throughout New Zealand but ours is close to the largest geographically and the smallest in terms of population. That has presented great problems in organizing the health care system. Because it is so rural, there is difficulty maintaining adequate numbers of physicians and the practices rely on Locum physician. like us from overseas but also from New Zealand. Also, the District Health Board has assumed management of virtually all the general practices, whereas throughout the rest of NZ there are many private practices in operation. The practice we work in now is not greatly unlike the community health clinics we have worked in in the States. Patients are charged a nominal fee and the practice receives funding from the District health Board based on the number of patients enrolled in the Practice. They do not get paid really for the services themselves, they are left to sort out how to best do that within some constraints.There is much reliance on advanced Nurses to provide a great deal of the preventative care and management of chronic diseases. I think the model is quite appropriate for the population.
The biggest change is in Prescribing medications.
Direct to consumer advertizing for prescription medications now approaches 5 billion dollars per year. A blockbuster drug makes 10 billion or so dollars, think lipitor or crestor or ability or prevacid.
The New Zealand health care system was aware in the early 1990s that they could not keep up with the obscene cost of these medications an founded a pharmaceutical board to address the issue. Know as Pharmac, the committee reviews medications and creates a formulary for prescribing including which drugs will be subsidized by the government. They are able to negotiate contracts with generic drug makes and then supply what I feel to be a very comprehensive list of medication to treat most conditions. If you are a health care policy geek, check out more information at ________________ http://www.pharmac.health.nz/about _____
Of course the US pharmaceutical giants hate this arrangement and are always trying to undermine it with trade agreements, perhaps why we never get New Zealand lamb at Costco, just a conjecture.
A downstream problem was created for the little pharmacies in the small towns however. With meds being so cheap, the pharmacies have very little profit margin. They make up for this by charging for the prescriptions fills, charging us and the patient if we make a mistake on the prescription that needs fixing, charging a fax fee if the script is faxed, etc. Our practice actually charges the patient for prescription refills, and the amount varies based on how soon it is needed. In fact, a patient who calls for a same day script is charged $20, more than they are charged if they come in for a visit with me and I write prescriptions, $17. ---
Lastly, check out this Semi:
This Semi comes about once a month. It travels all over the North and South Island with an OR staff, anesthesia and surgeons doing surgeries and colonoscopies at the more remote sites. It is actually privately woned and teh District Health Board hires them out. Very innovative.
So look forward to Carolyn's adventure on Cape Foulwind while I was on call for our next post
So given this is our hospital and we work in the most isolated part of New Zealand which has a very different medical system than most other parts,, maybe my observations should be taken in that context. We work for the West Coast District Health Board, one of many throughout New Zealand but ours is close to the largest geographically and the smallest in terms of population. That has presented great problems in organizing the health care system. Because it is so rural, there is difficulty maintaining adequate numbers of physicians and the practices rely on Locum physician. like us from overseas but also from New Zealand. Also, the District Health Board has assumed management of virtually all the general practices, whereas throughout the rest of NZ there are many private practices in operation. The practice we work in now is not greatly unlike the community health clinics we have worked in in the States. Patients are charged a nominal fee and the practice receives funding from the District health Board based on the number of patients enrolled in the Practice. They do not get paid really for the services themselves, they are left to sort out how to best do that within some constraints.There is much reliance on advanced Nurses to provide a great deal of the preventative care and management of chronic diseases. I think the model is quite appropriate for the population.
The biggest change is in Prescribing medications.
Direct to consumer advertizing for prescription medications now approaches 5 billion dollars per year. A blockbuster drug makes 10 billion or so dollars, think lipitor or crestor or ability or prevacid.
The New Zealand health care system was aware in the early 1990s that they could not keep up with the obscene cost of these medications an founded a pharmaceutical board to address the issue. Know as Pharmac, the committee reviews medications and creates a formulary for prescribing including which drugs will be subsidized by the government. They are able to negotiate contracts with generic drug makes and then supply what I feel to be a very comprehensive list of medication to treat most conditions. If you are a health care policy geek, check out more information at ________________ http://www.pharmac.health.nz/about _____
Of course the US pharmaceutical giants hate this arrangement and are always trying to undermine it with trade agreements, perhaps why we never get New Zealand lamb at Costco, just a conjecture.
A downstream problem was created for the little pharmacies in the small towns however. With meds being so cheap, the pharmacies have very little profit margin. They make up for this by charging for the prescriptions fills, charging us and the patient if we make a mistake on the prescription that needs fixing, charging a fax fee if the script is faxed, etc. Our practice actually charges the patient for prescription refills, and the amount varies based on how soon it is needed. In fact, a patient who calls for a same day script is charged $20, more than they are charged if they come in for a visit with me and I write prescriptions, $17. ---
Lastly, check out this Semi:
This Semi comes about once a month. It travels all over the North and South Island with an OR staff, anesthesia and surgeons doing surgeries and colonoscopies at the more remote sites. It is actually privately woned and teh District Health Board hires them out. Very innovative.
So look forward to Carolyn's adventure on Cape Foulwind while I was on call for our next post
Terrific descriptions. Envious of the payment schemes for the essential drug list. Why not Gov't pharmacies in lieu of private ones? This would reduce costs further!
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