31 January 2010

medicine

Ah, yes, medicine. The reason we're able to stay in NZ for a whole six months! It's a very interesting process, really, seeing and working in a new health system. Makes me feel like I'm a med student all over again! So here are the basics, from what I have figured out so far (don't hold me to it!!): NZ has both a public (paid for by general taxation) and private system. If you go through the public system, most things are covered (blood tests, imaging, etc), but if it's not urgent, you may be waiting for a while (weeks to months to even years). If you do purchase private health insurance, or just want to pay for it outright, you can get a specialist consult or test much quicker. Medications are also subsidized, but only certain ones--mainly these are the older, generic meds. For example, if someone comes in with depression, my options are basically the tricyclic antidepressants and prozac. If I think someone would do better on celexa, they apparently need to try and fail two of the other meds first. It's kind of like the insurance companies deciding what they'll cover, but more extensive.
Another interesting aspect is called ACC--it's the Accident Compensation Corporation which is separate from the public health system, but will help cover the cost of care from basically any type of injury that resulted from an accident--whether it be a motor vehicle accident, or you tripped and sprained your ankle, or it was an injury at work. It also covers some personal injury stuff, like medical mistake or error, sexual assault or abuse, and some work-related conditions. And you cannot sue anyone for compensation.
I'm working at the Ruanui Health Center, and has been staffed mainly by locums (traveling physicians) for the past at least three years. So that means most MDs are only there for 6-12 months, which means there is very little continuity, sadly. It's focused on Maori health, as well as being an access for the low socioecomonic folks as well, as it's cheaper than other private clinics--like $10NZD vs $50NZD for a private clinic. They also have a ton of community services provided by RNs that both see people in clinic and go out on home visits or other types of community events.
So a normal clinic day for me is also a bit different--the nurses have other roles here, so in my little 15 minute time slots, I get to go out in the lobby, get my patient, do vitals, get the history, physical, get a treatment plan or other investigations, and then chart it all by typing it into the electronic medical records. And I'm not a very fast typer. Typist?
Interestingly enough, since suing people is not done much at all, the medical records aren't like the states, where if it isn't documented, it wasn't done. Here, for example, the following counts as a full note: "Ear infection. Rx amox." Which also means that it's much harder to get an idea about a patient's medical history by just looking at the chart.
So that, thus far, is my understanding about the health system. I'm still working on my comprehension!

3 comments:

  1. Im liking your comparisons of the two systems - can you give more opinion on the differences. Here we don't sue, what do you think of that? Medical effectiveness of the system we use - does it work even though it might seem less sophisticated? Cultural differences perhaps? I dont want to put topics in your head, but more of your opinion please, its very interesting. Steve, Neuromuscular therapist - Auckland NZ.

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  2. Great post. If workplace injury is covered by the ACC, and since claimants who are covered by it can't sue, what's the employer's incentive for providing a safe workplace? And can people combine the public and private plans?

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  3. thanks guys! i don't think that the system is less sophisticated, just different and therefore takes me getting used to. and the clinic i'm in is different, as it seems that the other docs i'm meeting in the area have clinic set ups that are a bit more similar (as far as nrusing helping with rooming, vitals, etc). and den, we already talked about your bit!

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