USA and New Zealand Healthcare Compared

¶ … countries of the West and other major developed countries throughout the world are notable in many ways. Comparing and contrasting the two is just one way that very interesting topics and debates can be triggered. While many Western and other developed nations share strong commonalities, there are also very stark differences. The United States in particular is an outlier in many ways given how it does not have a universal system of any major sort while this is seemingly the norm with other Western nations, with Western Europe in particular being more in line with the universal strata. This report shall deign to compare and contrast the systems involved including how the finances are covered, how accessible healthcare is in the two systems and common outcomes for the two countries and their peoples.

Health Care Compared

When it comes to the healthcare systems of the more prominent Western and other countries in the world, comparing sets of two or more can reveal both similarities and differences that are quite stark. Just one pair of countries that can be compared would be New Zealand and the United States. While New Zealand and the United States are quite different in terms of their healthcare systems and they are located in rather different parts of the world, the comparison between the two is intriguing to say the least. New Zealand is a small country located near Australia in the Southern Hemisphere and the United States is one of the more dominant non-European countries in the Northern Hemisphere. This report shall compare the two countries in terms of how their healthcare networks and systems are comprised, how they work and so forth. While there are some common threads here and there when it comes to comparing the two countries, the differences are numerous and easy to see.

Analysis

According to Holtz, there are three main criteria when it comes to a health care system that is adequate. These three criteria include whether there is equal and equitable access to care that is related to both prevention and treatment services across both urban and rural populations, that the system is affordable for the common and average people that access that system including for those that have lesser to little financial resources and sustainable in the form of long-term financial and political support (Holtz, 2013). The model of healthcare in the United States continues to be a veritable mess of a system in many ways. What is meant by that includes U.S. health care model continues to be a complicated array or private and government providers, payers, insurers and programs that provide coverages for elderly and low income eligible individuals. This system experiences duplication, overlap, inadequacy, inconsistency, waste, and inefficiencies due to the missing dimension of system-wide planning, direction, and coordination (Shi & Singh, 2015).

Per the introduction to this report, the author chose the United States and New Zealand as the two countries to compare when it comes to their healthcare system. The United States is the home healthcare system to be compared and New Zealand would be the foreign one. Also as noted in the introduction, New Zealand is a country in the Southern Hemisphere. New Zealand is comprised of two main islands and the primary language of both if English. The gross domestic product (GDP) of New Zealand is ranked 49th in the world. A bit over two fifths of that (43.1%) comes from tax payments and other government revenues (CIA, 2016). In contrast to the deficits and debt of the United States, New Zealand maintains a national budget surplus at this time. Thus, this leads to a debt load that is only about a third (33.5%) of GDP (CIA, 2016). This stands in stark contrast to the debt of the United States. Indeed, the percentage of debt as compared to GDP is more than double, coming in at 73.6% and thus ranks much higher when it comes to debt loads in developed nations (CIA, 2016). Another very relevant fact to look to for both the United States and New Zealand is that the United States has an obesity rate of a third (33%) while the rate is only 28.3% in New Zealand. The level of healthcare-related expenditures in New Zealand is rather low, coming in at 10.3%. In the United States, that rate is much higher, coming in at 17.9%. The latter of those two figures is the highest in the world, developed and non-developed (CIA, 2016).

When it comes to the healthcare systems of both countries, the differences and similarities are easy to see. New Zealand has a hybrid system that is both public and private in nature. Both the systems offer a high standard of care. In the public system, the essential healthcare services of the country are provided free of charge to the people that use them and are eligible. This would include all citizens of the country as well as any people who work in the country on work permits that are two years or longer in terms of tenure (Medical Council of New Zealand, 2011). On the other side, there is the private system. These include private hospitals that provide treatments that are both emergency and non-emergency in nature. The one thing that tends to be excluded from this is accident and emergency care. Indeed, there is a clear differentiation and separation between accident and emergency care, which is a bit intriguing. By comparison, the United States would largely (if not completely) conflate emergency room visits and accident/emergency care into the same general system and framework. In any event, the network of private hospitals and clinics in New Zealand provide a great range of services. These include recuperative care, elective procedures and most common general surgical procedures. There are also private clinics that provide radiology and other testing/imaging services. These services generally require payment at the time the service is rendered or that a valid health insurance be in place to cover the costs.

The government-funded public health system in New Zealand works on a model that is community-oriented in nature. There are three key sectors to this system and they are as follows:

District Health Boards - District Health Boards (DHB's) are funded by revenues that flow into the government and they are responsible for providing and funding both health and disability services for the district in which they reside.

Primary Health Care - Primary health care is for routine and normal services. This would an array and collection of common and normal non-hospital services. Even with all of that, not all of the services are government-funded or paid for. Common primary health care include first-level services such as general medical practice, mobile nursing stations and networks and community health services.

Primary Health Organizations -- Primary Health Organizations (PHO's) are the local structures and frameworks that are used to deliver and coordinate primary healthcare services. PHO's work to bring together and amass teams of doctors, nurses and other healthcare professionals in the community so as to service the needs of the patients enrolled in the system.

The private healthcare system in New Zealand includes services from specialists, primary care doctors (PCP) and hospitals that are private in nature. This private system is intended to complement and interface well with the public system mentioned elsewhere in this report. The hospitals (private) mostly focus on non-emergency care and services while the public healthcare system focus on more acute and urgent needs of the public. Beyond that, there are also many private clinics that provide services for accidents, emergency services and other services. These services are often provided outside of the normal operating hours that are used by most doctors and clinics in the public system. In short, there is a framework in place so that all services and medical needs in question are covered by public locations, private locations or a combination of the two. For the public hospitals that exist, there is no charge to the patient so long as they have permanent residence in the country, as mentioned before (Waitemata, 2014). In most cases and for most patients, prescriptions from pharmacies cost no more than $5 per prescription filled. Also, drugs needed for children under the age of six are usually free. Families that needs more than twenty prescriptions in a year are extended what is called Pharmaceutical Subsidy Card (PSC). This card is based on a subsidy system and it typically reduces the charges and fees paid by the patient and their families (Waitetemata, 2014). Other services that involve no direct charge or fee to the patient would include things like mammograms and other breast cancer screening services for women aged forty-five to sixty-nine, cervical cancer and HPV treatment for most adult women and colonoscopy services for men and women that are aged fifty to seventy-four (Waitetemata, 2014).

One commonality between the two systems that was discovered is that pre-hospital ambulance transportation service was always billable to the patient. However, there is generally a waiver for people in households that are subscribed to the ambulance system (St. John, 2016). Inter-facility transfers via ambulance are usually of no additional charge to the patient as facilitating this is seen as a way to ensure continuity in care. The rates that apply, when payable, are quite comparable to domestic rates in the United States for both treatment and transportation charges that are part of the membership in which a patient or household is enrolled. As for other metrics between the two countries, infant mortality in 2015 was 4.52 deaths per 100,000 live births in New Zealand compared to 5.7 in the United States (CIA, 2016). Life expectancy in 2015 was 81.05 years in New Zealand and 79.68 in the U.S.A. (CIA, 2016). Another fascinating and relevant statistic is that the New Zealand healthcare system has 1,103 nurses per 100,000 residents. In the United States, that number is a mere 982 nurses per 100,000 (Nursing Council of New Zealand, 2011). When looking at that same ratio for doctors, there are 274 per 100,000 people in the country of New Zealand. In the United States, that number is only 245 per 100,000 USA. When it comes to available hospital beds, the number is 2.3 per 100,000 in New Zealand. In the United States, it is 2.9 per 100,000 patients (CIA, 2016).

To attain and gain a better perspective on how all of this relates to the norms seen and realized in the United States, one should compare incomes and taxes for the people in both countries. In New Zealand, the median income for the population as of 2015 was about $47,486 (Statistics New Zealand, 2016). In the United States, that same figure was $53,657 (Department of Numbers, 2015). The income tax system in New Zealand is much simpler and easier to navigate than the same system in the United States and its rather complex Internal Revenue Code. Of course, the Internal Revenue Code is controlled and regulated by the Internal Revenue Service and the laws or guidelines passed to influence the same. By contrast, workers in New Zealand are assessed straight income tax rates that range from 10.5% for the lower tier of wages all the way up to 33% for wages over $70,000 a year (Immigration New Zealand). In the United States, there is a progressive tax system that has tax rates that reach all the way up to 39.6%. The United States assesses additional taxes for high-income earners. However, this is not done in New Zealand. Taxes for corporations are a flat thirty percent in New Zealand and there is no capital gains tax assessed on unearned incomes (Immigration New Zealand). To put it simply, the New Zealand system of taxation is much simpler and much more efficient as compared to the system used in the United States. Beyond that, New Zealand also has a much more efficient method of feeding tax revenues back to the citizens in the form of healthcare and other services that are dispensed to the citizenry and authorized visitors.

A fair and full analysis of the New Zealand healthcare system reveals that they have very respectable healthcare statistics and their coverage for basic and preventative services is almost universal and usually free to the person receiving the services. Of course, the "free" services are paid for by the tax revenues paid by many of those same citizens but it is dispersed and given to the people need it rather than discriminating by ability to pay in a way that hurts the overall healthcare system. They do all of this despite the fact that the tax rates in New Zealand are lower than the same rates in the United States.

If there were to be some broad-based conclusions that could be drawn when comparing and contrasting the two nations, there are a decent number of them. For example, the healthcare utilization percentage in both countries is rather high. However, the United States system is really off the charts as compared to New Zealand. There is a confluence of high healthcare use rates, people having to struggle a bit (or a lot) to afford these services and people that drastically need these services due to having one or more chronic disease such as diabetes, heart disease or something else along those lines. In other words, there is very heavy use of the United States healthcare system and this is in large part due to the unhealthy practices and lifestyle choices that Americans tend to make as compared to other countries. Another conclusion that is not hard to reach is that both the healthcare and tax systems in the United States are entirely too complex and arduous as compared to the systems in New Zealand and other countries. Of course, everyone should be incurred and required to pay their "fair share" of taxes and pay their fair share of costs for healthcare services. However, making the system too complex for any reason is very harmful and inefficient and it leads to a system that is cumbersome and that does not perform at a level that is acceptable or ethical. Indeed, having a system that is complex just for the same of complexity and the status quo is not acceptable.

As for some recommendations that the author of this report would offer, they would include the following:

Greatly increase the amount of education and teaching programs for people that are at risk for diseases and disorders including obesity, diabetes, cancer, heart disease and so forth

Make preventative services free at time of service for all, whether it come from a healthcare policy mandate or whether it comes from tax-funded clinics or services in private clinics

Greatly simplify the tax code. It is entirely too complex and it is currently just a vehicle for the government to wield power and control over corporations and the people. The use of a flat tax rate or something very similar should be the norm. The combination of an elimination of the tax loopholes and a flattening of the rates used should be a good combination of keeping things simple and making sure that everyone pays their fair sure. Those below a certain income level should pay little to nothing in taxes but there should be no attempt to "soak the rich" in the form of tax rates that deter innovation and investment. There is indeed a "sweet spot" that exists when it comes to taxes. The rates should be high enough so that the optimal tax collection amount is reached but it should not be so high that people feel that they are working just to pay taxes. The Internal Revenue Code is entirely too complex and politicians and even some IRS officials alike are proving that they are using the IRS code to get even and/or settle scores. It should not take an advanced level of training or aptitude to figure out one's tax bill.

While a shift to a more government-oriented system is probably a good idea, doing so in the wrong way is not a good idea. Indeed, if the same amount of money can be spent on the Affordable Care Act and just simply buying private healthcare insurance policies for those that need it, then the latter is probably the better idea. While the amount of enrolled people has gone up a lot with the ACA, the amount of negative effects has been rather sizeable.