Fac­ing the wait or pay dilemma

The Horowhenua Mail - - CONVERSATIONS - ROB STOCK MONEY MAT­TERS rob.stock@fair­fax­me­dia.co.nz

‘‘Do you have health in­sur­ance?’’

Chill­ing words you never want to hear from a doc­tor.

They al­ways come just be­fore he or she tells you how long you’ll have to wait for your tests or treat­ment, if you don’t.

You also know when you hear those words that you are about to get a good deal poorer.

I heard those words 36 hours after tak­ing my first ever trip in an am­bu­lance.

An am­bu­lance ride is not a great end to an evening, but my diagnosis tends firmly to­wards vi­ral, rather than dodgy ticker.

But just to be on the safe side, my GP rec­om­mended some heart tread­mill tests.

Un­less I used my in­sur­ance, he reck­oned I’d be wait­ing many, many months for my time on the tread­mill, maybe as long as a year.

And so here is the choice I face: Do I wait for a date on the state sys­tem? Or, do I use my health in­sur­ance to jump the queue?

It’s a moral dilemma as well as a fi­nan­cial one.

The ma­jor­ity of health in­sur­ance poli­cies have fairly high co-pay­ments (the share of treat­ment/pro­ce­dure costs paid


Con­sider health in­sur­ance But save for health emer­gen­cies too

Think about long-ter­maf­ford­abil­ity

by the pa­tient), or ex­cesses (peo­ple of­ten opt for even higher ones to keep monthly pre­mi­ums down).

Claims can leave pol­i­cy­hold­ers fac­ing bills in the high hun­dreds to low thou­sands of dol­lars.

Ex­cept for ac­ci­dents, New Zealand has a two-tier health care sys­tem.

There’s the state sys­tem, which has helped Ki­wis live long and healthy lives.

And there’s the pri­vate sys­tem, funded largely by health in­sur­ance, which lets higher in­come folk go pri­vate to get ‘‘elec­tive’’ tests and op­er­a­tions done faster than on the state sys­tem.

Elec­tive means a pro­ce­dure that does not have to be per­formed im­me­di­ately.

State wait­ing lists can re­sult in peo­ple hav­ing to put up with dis­com­fort and pain for months, or in my case, lin­ger­ing un­cer­tainty.

Health in­sur­ance is most com­monly held by higher-in­come, work­ing age peo­ple.

Wealth counts when it comes to health.

There are around 1.37 mil­lion peo­ple with queue-jump­ing health in­sur­ance, which may help ex­plain why state wait­ing lists aren’t more of a na­tional scan­dal.

Health in­sur­ance pol­i­cy­hold­ers need savings to dig into when they make big claims be­cause of the ex­cesses/co­pay­ments ex­pected of them.

‘‘Wealth counts when it comes to health.’’

When a doc­tor asks if you have health in­sur­ance, you, the pa­tient, know you are fac­ing a ‘‘wait or pay’’ de­ci­sion.

The op­tion you choose will de­pend on your sense of ur­gency (pain, worry, etc), and whether you have the money to make the pay­ment, or need/want the money for other things.

This is why peo­ple with health in­sur­ance need savings too.

There’s an­other rea­son for pol­i­cy­hold­ers to be sav­ing.

The older you are, the higher the pre­mi­ums get, so many peo­ple let their poli­cies lapse when they stop work.

To be able to keep up their in­sur­ance after they re­tire, peo­ple have to amass enough wealth to be able to con­tinue to af­ford the pre­mi­ums.

If that’s not pos­si­ble, pol­i­cy­hold­ers just have to ac­cept health in­sur­ance is some­thing to help you to stay well while work­ing.


Elec­tive surgery can be ex­pen­sive, even if you have health in­sur­ance.

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