Medical Treatment; Are you a claim stat and don't know it?

Medical Treatment; Are you a claim stat and don't know it?

From time to time I get updates through from insurers with their claim stats. I recently posted a blog on medical coverage for un-funded medicines and had a look at insurance literacy for clients.

I like information, the sort of information that gets away from the typical and very usual FUD. Fear Uncertainty & Doubt that my industry often trades on to get sales. 

I rant a bit in this one; it is an issue we, collectively, don't spend enough time and energy on.

It is been commented in many online forums, that the scaring and very pushy what if? Isn't appreciated. I must admit I do not like it much either. Which is why I try and stay away from it and deal with the facts. 

Part of the reason people take longer to make decisions, but they do make better decisions as a result.

My point, while I do not trade on FUD, I certainly have some disturbing stories and stats. Some may look on the surface as FUD. They are based on the reality of you and me, the average person. 

The person getting on with life, family and business and gets knocked over with something unexpected and often unplanned for.

What’s this post all about?

It is about you, your health and how you can access treatment in a more effective way.

It is been commented in many online forums, that the scaring and very pushy what if? Isn't appreciated. I must admit I do not like it much either. Which is why I try and stay away from it and deal with the facts. 

Part of the reason people take longer to make decisions, but they do make better decisions as a result.

My point, while I do not trade on FUD, I certainly have some disturbing stories and stats. Some may look on the surface as FUD. They are based on the reality of you and me, the average person. 

The person getting on with life, family and business and gets knocked over with something unexpected and often unplanned for.

What’s this post all about?

It is about you, your health and how you can access treatment in a more effective way.

Why?

Because the public health system is quietly failing a significant number of New Zealanders.

The government paid for 158,000 elective surgeries in 2013 for 100% of the population.

The health insurers at a similar time paid for 140,000 surgeries for about 25% of the population. There are 110,000 people on waiting lists and about 170,000 people not even on a waiting list that we know about. Both from surveys and the ministry of health’s own stats.

Am I the only one seeing the problem with the math? It is quietly hiding things.

Let’s dig a bit deeper

140,000 x 4 = 560,000 (a rough 100% if everyone had health insurance) + 158,000 the public system did deal with, because some of the insured won’t have used their medical insurance for some reason = 718,000 people, roughly, in need, with something that needs/needed doing.

This excludes ACC surgeries, which for 2013 were 33,000 and emergency surgeries too. Emergency surgery will have dealt with some on the waiting list as they got too severe to wait, a difficult thing to quantify. (I am going to come back to this later)

Those surveyed who responded that surgery was needed, gave no distinction on whether it was public funded or ACC funded so that a good number may be ACC cases not public purse cases. Confused yet, I am, and I am pretty good with numbers.

Back to the numbers. 

Of the 718,000, 298,000 got their surgery, public and private, and there’s 110,000 on waiting lists with an estimated 170,000 who need surgery and are not on waiting lists. 

This leaves us with a possible 136,000 of the 718,000 people out there that probably haven’t been counted. Moreover, that is the need for just one year, based on the medically insured list.

Still with me?

Those are all big numbers! Family members, friends, co-workers, people in your community living with medical conditions that could be relieved with an operation, or two.

Ok, Why have I approached this in this particular way?

If you are paying a premium for an insurance cover, you are more likely to push for your surgery, than if you had to pay for it yourself, or you cannot push because you are waiting on the public system. Even though you have paid your taxes and you need the operation.

What this does not recognise is the poorer health, the lower social economic areas of our population have. I am not generalising or picking on a sector; it has been well documented in NZ health information. 

The latent need for health treatment and surgery is likely to be higher than the 'official' stats suggest. What is even more profound, when you step back and see nearly 1/4 of the population need surgery in one year, it really puts a perspective on how fragile the human body actually is.

Of the 110,000 on waiting lists and 174,000 estimated not on a list but should be and the 136,000 not even counted, possibly falling under the ACC provisions, but as you see these numbers add up to more than the ACC budget that follows.

ACC’s listed liabilities at 2013 were $2,646,000,000 or roughly about the 160,000 surgeries, give or take about 20,000, which is another measure of unmet need not reported in the articles, or it could be muddying things too. I cannot tell.

What causes me to scratch my head some more; ACC paid for 33,000 surgeries classified as elective in 2013, but have a provisioned budget of $2.6 bill for accident claims which have not yet received the treatment ACC expects to give them. Sound fishy? This is part of the reason ACC have dropped their levies; they have a massive pot of gold earning them money to pay for claims.

Touching on the lower socioeconomic sector again, We, population, DHB's, Government, etc. know the issue is there in the undereducated and ill informed. It is there, and we rely on ignorance and lack of education to keep it there. They do not appear in the stats that matter, though they appear with social workers and social services in other ways. 

It is not fair to those people in any shape or form. Frankly, it is a burden on society that is not their fault or doing, but it is there and needs addressing.

I have seen the comment made in social posts, the CFO to the CEO, if we spend the money training the staff they might leave, with the reply if we do not train them they might stay... 

Which leads to Sir Richard Branson's quote, Train people well enough so they can leave, treat them well enough so they do not want to.

We are not doing enough of the optimistic stuff to ensure our population is better educated, healthier and are more productive, not just in work and in income dollars, but in the family, community engagement and enrichment. This is the stuff that we live for, not the dollars and the job.

If any of this concerns you, and it should, and you do not presently have health insurance. Give us a call; we can chat about cost effective ways to get you covered, so you are not another statistic waiting around for surgery. 

Stuff - Elective Surgery gets a boost

NZ Herald - Kiwis face massive 'hidden' surgery wait list

Jon-Paul Hale

Written by : Jon-Paul Hale

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