1. International Education Experience: New Zealand
Glenn Dunne, MS4

2. Auckland, New Zealand
Largest city in New Zealand population: 1.3 million
Located on the coast of New Zealand’s North Island
Rotation site: Middlemore Hospital

3. Rotation Site Middlemore Hospital
800 bed public hospital located in south Auckland, New Zealand
Approx. 91,000 admissions per year; 354,000 outpatient encounters
Provides wide range of services, encompassing primary care and specialty areas such as plastic surgery and burn care

4. Rotation Experience Anesthesiology
Saw cases across wide range of specialties, such as general surgery, orthopedic surgery, plastic surgery, OBGYN.
Middlemore hospital largely covers “acute care” surgery. Elective cases tend to be covered at the nearby Manukau Surgery Centre.
Practice differences vs. United States
No nurse anesthetists
Metaraminol: α1-agonist with some β effect. Commonly used to prevent/treat hypotension
“Kiwi Ingenuity” – many New Zealanders embrace a do-it-yourself mentality. Unfortunately, this frequently results in injury. Middlemore has busy plastic/orthopedic surgery services.

5. Topic of Study: Comparing/Contrasting Healthcare Funding and Access in New Zealand and The United States
Healthcare funding/access is a major issue in the United States
All New Zealand Residents have access to healthcare
2014 healthcare expenditures, as percentage of GDP
New Zealand: 11.03% of its GDP
USA: 17.14% of GDP
Infant mortality rates, 2016
New Zealand: 4.5 deaths/1000 live births
USA: 5.80 deaths/1000 live births
Adult Obesity Prevalence Rate, 2014
New Zealand: 30.6%
USA: 33.0%
Life expectancy at birth, 2016
New Zealand: 81.2 years
USA: 79.8 years

6. Healthcare Funding in New Zealand
New Zealand has a mixed public-private healthcare system
Majority of New Zealand residents do not carry private insurance
Private insurance allows more control over provider choice and when/where patient is treated
Public health system subsidizes cost of many drugs – recipients pay NZ$5 per prescription

7. Determining Eligibility for Publicly Funded Healthcare Services
Eligibility criteria given in The Health and Disability Services Eligibility Direction 2011
Persons eligible for full range of publicly funded health/disability services
New Zealand citizens and permanent residents
Australian citizens/residents staying in New Zealand for 2 years or more
Persons with refugee/protected person status
Students studying in New Zealand and funded by a New Zealand University
Children that do not meet criteria, but whose parents meet certain criteria
Persons eligible for limited range of health services
UK citizens
Australian residents
Pregnant women
Eligible claims covered by the ACC (see next slide)

8. The ACC (No, not the Atlantic Coast Conference)
“Accident Compensation Corporation”
New Zealand has a universal no-fault accident injury compensation scheme
Funded by taxes on employees, employers, petrol (gasoline), and motor vehicle license fees
New Zealand’s only provider of accident insurance (for both work and non- work related injuries)
Covers all citizens, residents, and temporary visitors who suffer personal injuries
Multiple services covered, including direct treatment costs, compensation for lost wages, and cost of necessary home/vehicle modifications

9. Drawbacks to a Publicly-funded Healthcare System
Some patients experience wait times for non-urgent procedures or to see a medical specialist
Patients may wait up to 6 months to see a specialist
Private insurance allows patients more say in specific provider and scheduling
Public sector offers relatively low physician reimbursement rates as compared to the private sector. This has contributed to a physician shortage in the public sector
Many public-sector physicians also choose to work part-time in private sector
Occasional drug shortages, as government has to buy drugs in bulk/in advance

10. Conclusions New Zealand has a mixed public/private healthcare system
NZ: Greater access to healthcare, lower healthcare spending, but issues with wait times and physician shortages
Possible solutions
Increase midlevel providers, e.g., in anesthesia
Streamline medical training times
US: increase in public healthcare could provide improved healthcare access and decrease healthcare expenditures

11. Profound Clinical Experience
Patient with cardiovascular comorbidities undergoing orthopedic procedure
Anesthesia induction goes smoothly, but ~30 min. in to case, patient experiences episode of “ventricular tachycardia”
Code team called; determined that patient was actually in NSR and anesthesia workstation had faulty reading
Reminder to always consider “the whole clinical picture” rather than relying on one particular test or piece of equipment

12. Profound Cultural Experience
Maori (native New Zealanders) comprise ~15% of New Zealand’s population
Maori tend to have decreased rates of healthcare utilization and increased rates of obesity
One particular experience: Maori patient presenting for abscess drainage
Language barrier meant inadequate understanding of procedure steps
Patient experienced discomfort and confusion during the case, but expressed significant relief and gratitude for care after conclusion of procedure
Patient may have presented earlier if not for language barrier/relatively poor health literacy
Ta moko, traditional Maori face marking

13. Aoraki/Mt. Cook National Park
Tongariro Crossing

14. Abel Tasman National Park Geothermal Pools in Rotorua

15. References
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factbook/rankorder/2091rank.html#nz
Interview with Dr. Stapelberg