antipodes (n.): 1. two points diametrically opposite on the globe; 2. a nickname for New Zealand.
With that definition in mind, this hospitalist decided to seek a working sabbatical—not so much over dissatisfaction with my job back home, but to see how the other side lives with nationalized healthcare. Of course, moving to the beach in undeniably beautiful New Zealand never hurts, either. When it comes to government involvement and healthcare, the U.S. is in a distinct minority globally; New Zealand’s healthcare delivery system, while not diametrically opposite, offers some fascinating differences.
Last July, my wife and I, along with our two young boys, relocated to Ohope Beach, a quaint resort community on the northeast coast of New Zealand about 100 miles south of the nation’s largest and most well-known city, Auckland. I am now six months into a year’s assignment at Whakatane Hospital.
I do not claim to be an expert on the comparative aspects of national healthcare systems, and some of my observations are directly related to my move from an urban to a rural setting. Still, the differences between the health systems in New Zealand and the U.S. are striking. Compared to Americans, New Zealanders spend less money on healthcare, their medications cost a third of what ours do, they undergo less testing, and they spend less time in the ICU, yet they live longer. Additionally, the public sector pays for the health insurance of every single New Zealand resident.
Let’s dispense with a few dry facts:
- Healthcare spending as a percentage of GDP: in the U.S., 16%; in New Zealand, 8%;1
- Per capita spending on healthcare in U.S. dollars: $7,500 for Americans; $2,700 for New Zealanders;
- Percent of healthcare spending by public sector: U.S., 45%; New Zealand, 80%1
- Average life expectancy in the U.S.: 78.2 years (38th in the world); average in New Zealand: 80.2 years (13th in the world);2 and
- World ranking in infant mortality: U.S., 33rd; New Zealand, 27th.2
How are those figures possible? Does New Zealand employ death panels? No. Is there something in the water (e.g. statins and ACEs)? No. Is everyone a non-GMO, fair-trade, shade-grown, sustainably harvested vegan monk triathlete? Hmm.
Anyway, here are a few observations—from a hospitalist’s point of view.
Hospitalist by Another Name
My job title here at 100-bed Whakatane Hospital is “consultant physician.” The term “hospitalist” is not common, but it is exactly the job the consultant physician performs. Inpatient ward rounds make up the majority of the consultant’s role, and the only outpatient responsibility is a twice-weekly clinic to see patients referred from primary-care physicians (still called GPs here) for clinical questions. Because it’s a public hospital, we have house officers and junior physicians as well. Roughly, that means that the consultant examines the patient and formulates the plan, the junior physician does the new intake, and the house officer does all the writing.
As for the team, it’s a bit like working at the United Nations. So far, I have met physicians from New Zealand, Australia, Ireland, Sri Lanka, Spain, Jordan, Iraq, the United Kingdom, India, Zambia, South Africa, and, of course, America. Thank goodness we—and the patients—all speak varying degrees of English. It’s certainly a bit odd to find yourself misunderstood by someone else speaking your (and their) native tongue.
The work schedule is quite reasonable, or, as I have come to call it, “civilized.” It is a 40-hour workweek, 8 a.m. to 4 p.m. daily, with at least 12 hours of each week dedicated to nonclinical time in the form of reading, research, and teaching. The daily patient census per team is about 12, and the call (or “take”) ratio is about 1:4. With no nights and rare weekends, the whole experience is a welcome change of pace. For the Kiwis, this pace is perfectly accepted and expected, with little pressure to work harder, longer, or faster. Teatime is 10 in the morning, and breaking for a cuppa is just part of the job.