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Primary health organisations and their general practices are paid according to the number of people enrolled - not the number of times they see them.
"Human behaviour predictably will be to enrol as many people as possible who will never come in and see you, and to make yourself unavailable.
I presume the idea was that you get base funding for the number enrolled, then charge a fee to cover appointments. But they have a point, it comes across as a bit WTF in the current environment.
Honestly we couldn’t get into a good GP practice when we moved about 5 years ago, they were pretty much all not taking new enrolments. In fact the one that we did want to enrol at is still not taking new patients.
Some of them are now really strict and enforce time limits for appointments, not allowed to bring up more than one issue unless you make a double appointment. We had an amazing GP when my first daughter was born, always took time to answer any questions and never rushed us and gave lots of recommendations to look at.
Since moving away we haven’t had great experiences through a few different practices.
Yeah I think that's becoming a more common experience. A lack of doctors makes things pretty difficult.
I'd like to see free GP visits for anyone low income and standard prices for everyone else.
Huh. I had assumed this was already the case, but it seems Community Services Card holders get cheaper visits but not free ones. That's probably a good election promise for someone to offer.
Nope, and people on benefit who are sick get the same jobseekers rate but are expected to keep bringing medical certificates regularly, which of course their GP charges for. That stops if they can get on the supported living payment, but the last National made that extra difficult.
I have to deal with WINZ from time to time, and it has made me a big supporter of a Universal Basic Income. They are so difficult to deal with by design. It's horrible.
It's not entirely design, though again the last Nat. Govt. added some true bullshit. It's also a whole lot of under-investment in IT, lack of coordination between policies and results, unwieldy legislation, truly stupid KPIs, etc.
I'd love a UBI though.
Or at least stop assessing people for benefit on their relationship status. It's stupid and it punishes people for normal human behaviour.
As an example, you log in to your WINZ account, and click the button to contact them. It gives you a phone number!
I get a form I need to fill in. It says to upload to my account, but I need to call them first so they turn on uploading for me to do it.
It's so unnecessarily difficult.
Or at least stop assessing people for benefit on their relationship status. It’s stupid and it punishes people for normal human behaviour.
I get that people in a relationship tend to share expenses. But you spend so much staff time arguing over whether someone is in a relationship. And friends share expenses too (flat mates), so really it seems archaic.
I know the turn on upload thing is because they're afraid if it's always there someone will DoS them by uploading way too much stuff.
Because it'd cost too much to integrate the system that holds the files and the system that uploads them so that anyone loading too many could get blocked...
If two working people split expenses, it's easier for both. If two beneficiaries split expenses they're expected to do so on less than theyd get if they just had a flatmate. And if one of them is on benefit and the other isn't, it's even worse - no relationship for beneficiary unless their new SO is willing to start financially supporting them.
I know the turn on upload thing is because they’re afraid if it’s always there someone will DoS them by uploading way too much stuff.
Because it’d cost too much to integrate the system that holds the files and the system that uploads them so that anyone loading too many could get blocked…
IRD does it great. You can message them through your account, and upload supporting documents to submit at the same time. Many other government agencies allow upload of documents. It's not like it isn't a solved problem.
As I understand it WINZ have recently started a massive project to replace their major legacy system, so I hope they redo their online stuff to make it more customer friendly.
If two working people split expenses, it’s easier for both. If two beneficiaries split expenses they’re expected to do so on less than theyd get if they just had a flatmate. And if one of them is on benefit and the other isn’t, it’s even worse - no relationship for beneficiary unless their new SO is willing to start financially supporting them.
I forgot about that part. WINZ basically forces your partner to look after you, without regard for how you're managing your finances. WINZ needs a full overhaul.
On the messaging thing, basically IRD has way, way, WAY less services and often MSD needs a bunch of info to do anything. So they try to steer everyone into forms that in theory elicit all the information. Doesn't work, but also they definitely don't have the resources to have involved email conversations with everyone. They can't even answer their phones and unlike with taxes people can't wait 2-6 weeks for a response.
Would be really nice if they could though.
Yeah, this is why I'd prefer a UBI. It solves or reduces most of these issues.
I agree UBI would be nice and then WINZ could just provide extra help for people who want to work but have no idea how to present themselves, or who have other complicated problems (like needing a no interest loan to escape a bad living situation, hardship grants, stuff like that).
I don't understand how a UBI wouldn't just cause inflation.
In my imagined version, you adjust tax brackets so people keep approx the same take home pay, and people on benefits/super receive approx the same amount.
Unfortunately with a major overhaul of policy where you give out free money but no one is better off, well you can't really sell it politically, so I can't see it ever happening. But that would be my ideal implementation for a starting point.
Thanks for the explanation, that kind of makes more sense than just giving everyone the same amount.
So I'd pick a baseline, probably the NZ super single person payment, then make this the amount for everyone.
Then adjust the lower tax bracket so everyone working and earning over that threshold ($14k) would pay slightly more in tax, about the same as the new payment.
Then get rid of all benefits and superannuation (but keep the other assistance payments like accommodation supplement, disability allowance, etc).
This does leave some people slightly better off, but it shouldn't cause more inflation than any other election bribe.
It then gives you a starting point to e.g. raise the UBI towards the living wage equivalent, make some supplementary payments standard and give them to everyone, etc.
Details would need to be worked through by a policy team, but at a high level I think this would be a big benefit to the country.
Makes sense. NZ super single is about twice core benefit. That would pretty much lift everyone out of poverty super fast.
Our gini coefficient would shrink and our entire society would get the bonuses to health and economy that go along with that.
Right, I want to vote for you at the next election.
Haha it may make sense but it's not a vote winner. Your average voter will think spending hundreds of millions on WINZ reform just to make it more complex (now we need a bank account from everyone in the country so they can be paid from two sources) is not a good idea, and the right will for sure be telling people no one will work and the economy will collapse even though trials overseas have not had this effect.
True, true. I think we spend millions on pointless cosmetic winz remodels pretty much every time we get a new govt, but people never notice.
They also don't train their staff properly. No two people in there will have the same idea about how/what to do. It's crazy.
There's an insane amount of different things all of which have different rules for for parents, or under age 25, or over age 65, or single, or getting something from ACC, or has a medical certificate, etc.
Also of course you get people applying policies that are out of date or that some manager decided on their own without consulting anyone.
And then there's the various rules suspensions that happen whenever there's a natural disaster, or a catastrophic IT failure, or an angry government, or a lawsuit.
Why not free for everyone? Higher earners already pay higher and more tax. And it avoids that people wait too long before going to a GP, saving costs as well.
I'm from Europe where a GP is free for everyone and it's amazing.
Mostly just because I think we should be eating the rich anyway.
The only credible solution on the horizon for a small country like ours is AI. I am deadly serious. An AI tied to your smart watch or health monitor can literally observe you 24X7 and catch many problems before they occur. One AI can be the first line of defence for all of NZ. Also AI can answer many question online for people who are worried about various symptoms. Even is the answer is "make an appointment with your GP".
We need more lower level tiers in our system like A&E too. Clinics where people can walk into 24X7
Yeah, healthcare with its heavy staff shortages is an ideal industry for some AI help. The ethical concerns involved present a high barrier to implementation though, I think.
I don't see why there would be any ethical concerns. An app that detects your heart rate has been higher than normal and asks you a series of questions to diagnose why would be far superior to you not even noticing the problem until the day you pass out behind the wheel right?