Accessing ‘free’ medical care

We have a really good medical system in New Zealand. The expensive things we need are either fully or partly funded most of the time. There are no barriers to good care whether you’re rich or poor, because the system treats everyone equally. Or does it?

There are some real issues that people on lower incomes face when it comes to seeking appropriate medical care, things that can mean their child does not hear, or ends up with rheumatic fever, or other wonderful things, for a few reasons.

One is the ability to take time off work. Many people on low wage jobs just cannot afford to take time off work for hospital appointments. Taking time off may even put their job at risk – totally illegal, of course, but in some places if you take time off then your position may end up disappearing. Even if the employer is understanding, taking time off means less pay that week, and when you’re struggling to keep food on the table that’s just not something you can do unless you have some way of making up the hours.

Say you’ve managed to get the time off work. How long is it going to take, asks the boss? And the answer can only be, “Ask the gods. It is beyond mortal knowledge”. There is the issue that all people visiting the hospital face, in that no-one know if the clinics are running on time, or how long an appointment will take. I’ve breezed in ten minutes early, been called right away, and been in and out of the office in ten minutes flat, for a total time of less than it take to hit the paid parking threshold of half an hour, marching down hospital corridors inclusive. On the other end of the scale, I’ve sat in a clinic waiting room for over an hour just to have a pre-appointment check, then hung around another half an hour for the specialist, and then spent half an hour with him going over treatment options. It can go either way, but mostly somewhere in the middle.

Before and after this, though, are poor people problems. Many people on low wages don’t have vehicles, and so rely on public transport. This can add so much on – for example, living in my old suburb, I was about ten minutes by bus from the hospital. My school was maybe ten minutes’ walk from the bus stop, and the bus came every 15 minutes. Assuming we just missed the bus, then (as you always seem to do), it would take 25 minutes for my parent to get me from school, and get to the hospital. But the work bus stop was a 30 minute bus ride from the school stop, and work was ten minutes from the work bus stop. So in total, it’s 50 minutes to get from work to school, 25 to get to the hospital, an unknown time at the hospital, and then reverse it all to get back, with a padding of at least fifteen minutes each way to account for the vagaries of buses. Two and a half hours of travel time, plus maybe an hour at the hospital. Yeowch. There’s a whole morning of work gone.

In addition to this is the cost. On a low wage, every penny is accounted for, and bus fares aren’t as cheap to a poor person as they are to a rich one. All that to-ing and fro-ing will cost upwards of $10, which is quite a bit of money when your food budget for the family is less than $100. Or say you have a car – but every drop of petrol is rationed. That leave you with some choices – run out of petrol and be double-screwed because you also lost hours so you can’t afford extra petrol, or maybe only do the hospital run that day and lose an entire day’s pay, or give up altogether and just go to work. Option C is often only economically feasible one.

Then there is the problem of rescheduling. Where you have time off work, all arranged, and then the afternoon before you get a call saying that you’ve been bumped due to an urgent case. Or, as wonderfully happened to my family once, you’re in hospital with a child that’s been deprived of food since bedtime the night previously, and are told at 1pm that surgery will not go ahead due to several emergency caesareans, and could you please come back and do it all again in a month?

Things like this can be managed on a higher income, and even to a degree when on a benefit, although that’s infinitely harder. But on a low wage, they’re major barriers to accessing the free medical care that New Zealanders are entitled to. It means that kids needing hearing aids, with the half-dozen sometimes long appointments that entails, may go on not hearing. Anything that can reasonably be skipped will need to be.

Kids with sore throats may not get seen to in primary care for other similar reasons, and this is one of the reasons why rheumatic fever is more prevalent in poorer communities. If Mum and Dad don’t get off work until six, they aren’t around in time to take the kids to the cheap or free health clinic, which may be located in an area that requires many bus trips. They certainly cannot afford taking a kid with ‘just a sore throat’ to after hours, where just seeing a doctor can cost upwards of $70. That’s just too much. And so, minor ailments like a sore throat have the potential to become serious illnesses like rheumatic fever. An infected cut has the potential to turn to cellulitis or septicaemia. And thus the emergency room after work becomes a wasteland of illnesses that could have been treated earlier if life wasn’t quite so hard on the lower-paid people in society.

I don’t know what the answer to all this is. Better paid leave for parents who need time for this sort of thing (or people caring for anyone really – or themselves!)? Travel subsidies that will cover the cost of nearby travel, instead of cutting in at 80km of travel for kids or 350km for adults? Maybe a combination of these things and things that brighter minds than mine can conjure up might make access to health care the equitable, available to all dream that our national health care system was set up to fulfil.

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