The New Zealand health system

Living in New Zealand certainly has its health benefits – a public hospital system that provides in the case of emergencies and the ACC insurance scheme that steps in for accidental injuries. Plus, for those who want extra choice and certainty there are many private healthcare providers, who can be used for treatment directly or via private health insurance. 

What can the public health system provide?

The public health system provides emergency healthcare for New Zealand citizens. If someone is ill with an acute, life-threatening illness or is seriously injured in an accident, they should call an ambulance, contact their doctor immediately or go to their nearest accident and emergency clinic.

What if the condition isn’t acute?

If the medical condition isn’t acute, the patient should make an appointment with their usual doctor. If they are not registered with a regular doctor, they can visit any health service provider. The health service provider may be able to diagnose and treat the condition or may refer the patient to a specialist health service provider.

Health insurance could help here: If the patient’s health insurance policy allows it, they might be able to claim for the cost of their doctor’s appointment.

When does ACC apply?

If the doctor decides that the patient’s health condition or injury is the result of an accident, they will be processed by the Accident Compensation Corporation (ACC). See www.acc.co.nz for more information.

What if they need specialised help?

The doctor may decide that specialist help is needed to help diagnose and/or treat the patient’s condition. Some doctors concentrate on specialty healthcare services. Some examples are ophthalmologists (eyes), orthopaedics (muscles and skeleton) and oncologists (for cancer).

Health insurance could help here: If the patient has private health insurance they can choose which specialist health service provider they would like to see and make an appointment for a time that’s convenient to them. Once an appointment is booked, they can ask their doctor to forward the relevant case notes and test results to this specialist health service provider. 

If they don’t have private health insurance, depending on the demand in the public health system, they may have to wait for an appointment. The priority assigned to their case and the length of the waiting list in their region will determine how long they have to wait. They won’t normally be able to decide which specialist health service provider they see or the time and place of their appointment.

How many appointments might they need?

It’s common for a patient to have an initial consultation with their specialist health service provider, followed by some tests. If  surgery is required they will have a pre-surgical consultation, the surgery and a post-surgical consultation, as well as any follow-up rehabilitation appointments.

Health insurance could help here: If the patient’s health insurance policy allows it, they may be able to claim for the cost of these consultations, tests, surgery and hospital care. They will need to apply for prior approval if the costs are likely to exceed $1000 or if the treatment involves any form of surgery or hospitalisation (even day stays).

What if the patient needs surgery?

If surgery is recommended and the surgeon is a Southern Cross Affiliated Provider, the surgeon will contact Southern Cross for prior approval on the patient’s behalf. If not, the patient will need to arrange prior approval with Southern Cross. It’s important that they understand what Southern Cross has agreed it will pay for and what (if anything) they will need to pay for.