This is underscored by a study by Crampton et al. of GP utilization rates in major “third sector” primary care organizations, all members of the Aotearoa Health Care network serving low-income populations with low or no co-payments. Like Malcolm, they found that overall GP utilization in per capita practices was low and much lower than in fee-for-service practices. However, in contrast to other studies, utilization rates for Māori were higher than for Pakeha for all age groups, reflecting the iwi base of multiple organizations and the importance of cultural and financial influences on utilization.

Geographic factors are also important for understanding levels of inequality in GP utilization. Given the strong correlations between distance and utilization patterns in both GPs and hospitals, it is not surprising that suboptimal utilization patterns are also locality-specific and result from the degree of “surplus” or “shortage” of GPs in a given area. This is clearly demonstrated by Malcolm, who showed that spending on poorer populations was 30% less than expected under the 1998 Health Care Financing Authority funding formula, compared to an undefined “affluent population”. population that was “overfunded” by 40%. Such patterns reflect the long-documented shortage of GPs in such areas and the impact of such barriers on limiting utilization. In contrast, demand driven by providers in wealthier regions with more physicians is potentially one reason why patients in such regions tend to receive more than their fair share of care, although there is still much debate about this issue.

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• Workforce shortages are causing pressures in many health professions, and many health workers report feeling burned out;
• Primary care providers such as GPs are doing more work and it is more complex. Many practices have had to close their books to new patients;
• Current funding models are not working well for primary care providers and their patients;
• Fragmented health care means that there are not always good links between different types of primary and community health care;
• Primary and community health care providers do not always have the necessary tools, including infrastructure and technology.

Most New Zealanders access health care through local primary and community health services. For many people, the current healthcare system works well. However, some groups, including Māori, Pacific, women, people with disabilities, people with low socioeconomic status, rural people, refugees and migrants, and rainbow communities, face greater challenges in accessing primary and community health care.

Some of the challenges people face include:

• Cost, including patient co-payments and service fees;
• Lack of services, including difficulties with making an appointment or getting an appointment with a GP. Some GPs have closed their services to new patients;
• Difficulties with access to services, including after hours, especially for rural communities;
• Focus on treating problems rather than preventing them;
• Cultural insecurity – under-representation of Māori, Pacific and people with disabilities in the workforce, and inconsistent cultural and disability competencies.

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Medicines are mostly prescribed by a doctor, and in free access you can find only the most basic drugs, for example: Ibuprofen, Panadol, lozenges, cough syrups and so on. In addition, medicines in New Zealand are quite expensive. The cost of individual drugs can reach 100-200 NZ$. If you belong to the part of the population eligible for subsidies, the cost of prescription drugs will be only 5 NZ$.

Dentistry

Dental treatment in New Zealand is not covered by the government and the cost is not suitable for everyone. For this reason, many New Zealanders travel abroad for dental treatment. The approximate cost of dental services in the country is: 60-100 NZ$ for an examination; 150-300 NZ$ for filling one tooth. Standard medical insurance covers dental services for at best 500-700 NZ$ per year.

Pregnancy and childbirth in New Zealand

Childbirth in New Zealand is a free service for those who fit the subsidy criteria, as well as their partners. New Zealanders do not consider expecting a baby and childbirth to be a disease requiring special care, so the supervision of a normally ongoing pregnancy is carried out by a midwife, meetings with whom most often resemble a sit-down with a girlfriend.

For those who cannot or do not want to give birth with a midwife, there is always the option of a paid clinic with all the specialists and a personal doctor who will not only manage the entire pregnancy, but also deliver your baby. The cost of services can vary depending on the clinic from 4 to 8 thousand New Zealand dollars. The difference in paid and free pregnancy is that it is the doctor that you will communicate with throughout your pregnancy. In case of questions and necessary examinations you will not need to go and get directions to the doctor, all the nuances of your pregnancy and labor will be in the hands of one specialist.

After the birth, mom and baby are transferred to a special postpartum Birthcare facility, where, as a rule, there are no doctors. Here, the young mother is taught how to care for her newborn. It should be said about paid maternity leave in New Zealand, from July 1, 2018 it is 22 weeks, but the workplace will keep you for another year (if you have previously worked a year in the company).

During maternity leave you can receive payments equal to your salary, but no more than 538.55 NZD per week before tax.

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• Enjoy substantial discounts when you visit your chosen general practice clinic. For patients aged 18 and over, the subsidized cost of a GP visit will be between NZ$10 and NZ$70. Without the subsidy, the cost is doubled. Prices vary by region and health care provider;
• Take advantage of free GP appointments for children under 13 years of age. Please note that this service is not available at all clinics;
• Take advantage of substantial discounts on essential medicines. At GP appointments, patients receive a prescription for fully subsidized medications at $5 for adults and free for children under 13;
• take advantage of free immunizations for children under 18 years of age;
• avail of free basic dental care for children under 18 years of age;
• Take advantage of free medical care for childbirth and pregnancy;
• Access to free diagnosis and treatment and inpatient care at the hospital. If necessary, the GP will refer the patient to a specialist. The patient is automatically placed on a “waiting list” for a specialist, the waiting list for which can last for days or months;
• Use free interpreter services for medical care;
• get a High Use Health Card or “frequent use card”. The program is designed to help reduce the cost of doctor visits and certain medications for those who have to see a GP more than 12 times a year;
• Get a Community Services Card, a “social assistance card.” The program aims to reduce the cost of getting medical care for those on low incomes.

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Another useful resource is ProCare. Here you can find out about clinics near you, their rates for appointments, and additional information.

The cost of medical services in New Zealand is very high. Residents of the country and some other categories of population can get help practically free or with a big discount. All this is thanks to subsidies from the country’s government. In order to receive subsidized assistance, you must meet one of the following statuses:

• Have New Zealand citizenship;
• have a resident visa;
• have a work visa, BUT only if the period between your actual entry into the country and the end of your current work visa is at least 2 years.

Even if you fit all the criteria, you may need proof of eligibility. This mainly applies to holders of work visas. If you have problems getting the subsidies you are entitled to, the best thing to do is to provide a printout of the subsidy terms and conditions that will prove your eligibility.

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Primary healthcare is primary health care, which is provided by general practitioners: GP – General Practitioner (analog of our therapist), nurses, pharmacists, physiotherapists, nutritionists, etc. The primary sector is chargeable for all patients, regardless of visa status (except for children under 13). If a patient qualifies for subsidized care, the cost of admission can be reduced by 50%.

Secondary healthcare is the care of highly specialized doctors, including hospitalization. This also includes maternity care. Specialist appointments and services provided by public health facilities are free of charge if the eligibility criteria for the subsidy are met.

Primary care is provided by a diagnostic general practitioner – GP General Practitioner, aka family doctor. The GP is the link between the patient and the health services. You should make an appointment to see a GP for any ailment. He conducts an initial examination, prescribes medication and, if necessary, refers the patient to a “narrow” specialist for further examination. Note that the appointment to specialists is not at the patient’s request, but at the discretion of the GP, and, most often, for this there must be sufficiently strong objective reasons, not just a feeling of indisposition. To get immediately to the necessary specialist is possible only paid in private clinics.

It is worth noting that the GP is a doctor, a broad profile, taking all the responsibility (with the resulting responsibilities and circumstances) about his patient, to him or her get the results of examinations of the patient, the notes of specialists on narrow problems. In other words, it is a kind of a personal physician, who guides a person and his health for years.

If the medical condition is serious enough, the GP will make an appointment to see a specialist. What is different is that the waiting time for an appointment can be several months. You can reduce the waiting time by using health insurance or paying for the appointment yourself. Typically, the cost of an initial examination will be NZ$150. You can also go to a private clinic. An appointment can cost you 300-500 NZ$, depending on the specialist.

Treatment is effective and the overall level of quality of medical services is high.

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