Health Insurance – Do You Need It? Episode 78

Having health insurance gives you peace of mind knowing that you and your family can get the medical treatment you need, when you need it.

If you are diagnosed with a non-acute medical condition, you could have a long, uncomfortable wait for treatment from the public health system. For private treatment you can expect to pay thousands of dollars for some common operations. Without health insurance, these can be hard to afford. It’s a way of avoiding public waiting lists and access the best medical care when and where you need it.

First, let’s explain what the public health system covers:

• Acute care – urgent & unplanned health care due to illness or injury. It’s time sensitive and can result in death or a disability if the person isn’t seen immediately.
• Planned care is for anything that falls outside of an emergency or urgent care. How people are prioritised is based on age, severity of condition and location. What you may think is urgent, may not be urgent to the specialist and you will be placed on a public waiting list.

A good health plan will cover 100% of your major medical expenses, minus any “excess” and includes things like surgery and hospital charges. Many plans cover a range of diagnostic costs like MRI scans ($1,500 to $3,000), CT scans ($1,300 to $1,700), ultrasound ($500 to $1,500) for before and after treatment in hospital.

How much does it cost?

32-year-old male – well rated cover

No excess – around $95 per month

$500 excess – around $70 per month

$1,000 excess – around $60 per month, add specialist and tests for around an extra $30

A lot of people think they don’t need it as they can rely on the public system. If you have been paying attention, there is a current lack of nurses and doctors all while Covid continues to cause havoc on what is already a health system under pressure, we have burnt out medical professionals so things aren’t happening as quickly as many may think.

The government said in March that nearly 36,000 people had been waiting longer than 4 months for their first appointment with a specialist. There have been reports from the Breast Cancer Foundation, women are waiting 6 months for their first appointment and 50,000 mammograms have been pushed back. This is a huge concern when breast cancer is the biggest killer for women under 65.

So there are delays. Now if you can deal with waiting, that’s great but then there comes the cost. The average cost for the most common surgery in NZ is $20,000 and this doesn’t cover the diagnosis, post-surgery medication or rehab.

Common procedures like a colonoscopy are $2,000 to $3,200.

Removal of the appendix – $9,000 to $13,000.

Hip joint replacement $22,000 to $28,000.

Chemo can cost $15,000 to $170,000 per treatment cycle.

Radiotherapy $20,000 to $55,000 per treatment cycle.

In a 2020 study it was found “health” is the biggest category in donation-based crowdfunding globally. In New Zealand, this includes over 400 individuals and families who share their stories of illness, accident or disability online each year.

Of those, nearly 42% of the campaigns were related to cancer. 71% of campaigns were for illness compared to 11% that related to injury. There were also dozens of campaigns that had nearly no donations! You have to ask yourself what happened to them?

Some stories on the public waiting list from NZ Herald

• A young boy waited six months with reduced vision for an appointment, before his mum took him to a private ophthalmologist who diagnosed him with a brain tumour.
• A 68-year-old man in Otorohanga died while on the waiting list for a triple bypass surgery.
• A grateful man who had his hip replacement surgery documents his journey with health insurance and tells the grim story of those who aren’t as fortunate.