New Zealand

New Zealand's population is 3,820,000, which puts it between Oklahoma (3,450,654) and South Carolina (4,012,012) in size.. The infant mortality rate is 6.39 deaths/1,000 live births and life expectancy is at 74.85 years for men and 80.93 years for women. This is slightly better than in the US, but essentially similar.

New Zealand's GDP per capita is a rather low $17,400. They spend only 8.1% of it, or $1410 on health care. This is 32%, or less than 1/3, of US expenditures, and yet the results are as good or better.

In 1941, New Zealand achieved universal coverage and was the first country with a free-market economy to do so. Radical health sector restructuring occurred in 1993, which introduced a set of market-oriented ideas. However, the new system performed poorly and was thus again restructured 3 years later

The health system is funded through taxation and administered by a national purchasing agent, the Health Funding Authority (HFA). Health care is provided by 23 hospital provider organizations (Hospital and Health Services), GP's (most of whom are grouped as Independent Practitioner Associations, IPA's), and other noncrown providers of child care, disability support services, etc. These parties compete for the provision of health services. Public funding accounts for 76% of health expenditures. Complementary, non-profit, private insurance, on the other hand, covers about 1/3 of the population and accounts for 7% of health expenditures. It is most commonly used to cover cost-sharing requirements, elective surgery in private hospitals, and specialist outpatient consultations. New Zealand's government is a purchaser and provider of health care and retains the responsibility for legislation and general policy matters.

Health care is free for children, and all patients have their free choice of GP. Out-of-pocket payments account for 17% of health expenditures. GP's act as gatekeepers and are independent, self-employed providers. They are paid via fee-for-service, partial government subsidy, and negotiated contracts with HFA through IPA's. The payment system is currently moving from fee-for-service to capitation. Private insurance and out-of-pocket contributions pay the remainder. Hospitals are mostly semiautonomous, government-owned companies that contract with the HFA. Specialists are commonly salaried, but may supplement their salaries through treatment of private patients.