It’s summer here, which means a bit of a respite from kids with respiratory illness and fever in the Emergency department, but an uptick in injuries.  Falls, motor vehicle collisions, bike accidents, and of course playground injuries have been commonplace. The “flying fox” (Kiwi version of the zip line) has been a particular good referral source for us, as have the electric scooters now making their way to Gisborne.  Gravity is having a great month here in Gisborne.

It seemed a good time to discuss New Zealand’s Accident Compensation Corporation, or ACC- the country’s universal no-fault accidental injury system, which provides financial compensation and support to all citizens, residents, AND temporary visitors who have suffered personal injuries.  The program has been around in some form for 30+ years in New Zealand. Essentially, if you are injured in New Zealand, whether on the job, on the highway or at a public park, you are covered for your medical care.  It’s a pretty sweet deal for Kiwis.

The purpose of the ACC is to “abolish claims for personal injury in exchange for a social contract” by which those who suffer personal injury receive care and compensation, but in exchange give up their right to sue for damages.  By having this program in place, the “economic consequences of injury are spread across the community irrespective of where fault may lie”. There’s no finger pointing when randomness happens, no frivolous lawsuits over icy sidewalks or water on the floor at the grocery store, and no fear of “not being covered” if mishap occurs to you or your family.   Its goal is to achieve equality of compensation, while reducing costs of litigation.  

Before you think that Kiwis have a green light to go out and act stupid… laws are in place to protect citizens from themselves- for example, EVERYONE must wear a bicycle helmet, including adults.  Seat belt and DWI laws are strictly enforced and random checkpoints are commonplace. But if something unexpected happens to you, then your ED bill, subsequent acute care, and in many cases 80% of your wages are covered.   You can still hire a lawyer and sue for punitive damages (pain and suffering) if you choose, especially if something egregious or criminal happens to you, but you forfeit the right to sue for personal injury.

The program is funded through a combination of employer contributions, individual income taxes, gasoline sales, and DMV fees.  Like any government program, there is of course potential for fraud and abuse, and I’ve heard of cases that would make you groan.  

But the program helps to explain why neighborhood skate parks can exist in just about every town here in NZ, how we were able to bring our five-year old whitewater rafting, and how places like the Rere Rockslide can exist at all.

It partly explains why there are fewer lawsuits in general, including medical malpractice, and less personal injury attorneys per capita here as well.  (Interesting footnote – NZ is third behind the US and Brazil in terms of TOTAL lawyers per capita. They must be practicing other types of law here).

Implementing such a program in the United States would be fraught with challenges.  65X more people alone would mean exponentially more opportunity for fraud and abuse.  Individual states would have to agree to terms on covering residents, visitors, and coverage laws in general.  Live in DC, injured in Virginia but work in Maryland? It would get complicated very quickly.  This is assuming of course that the American Bar Association would allow such a program to happen (spoiler alert- they wouldn’t).   

It’s an interesting program however, particular as discussions around “Medicare for all” have begun to resurface back home in the House.  The ACC does not account for medical illness, cancer, etc. But it likely makes the COST of health insurance less if you factor in the reduced costs of litigation.   

I’m generally in favor of a public option for healthcare, akin to the public school system, whereas everyone gets a reasonable level of basic care and those who want something faster or different can pay for it.  My personal criticism of “Medicare for all” options are that they provide TOO much, in terms of the potential costs, without putting enough of the onus on individuals to have more personal responsibility for the medical portion of their health- whether it be risk factor modification for medical illness (smoking for example), or basic self-care for self-limiting medical problems.

A US program akin to the ACC would cover bad luck and mishap.  It would not address bad genetics, bad luck with cancer, socioeconomics and access to healthy foods, mental health, drug and alcohol dependency, maternal and pediatric care, and a host of other aspects of health care that are important determinants of overall health.  But it would help young people, who for the most part require very little scheduled medical services and for whom injury is still a leading cause of death, disability, and personal bankruptcy.

I know why it won’t work in the US… but is there an element of this program that just might?

Jesse Irwin

Jesse Irwin

It's Jesse. I'm an emergency physician and healthcare leader, a Navy veteran, a father of three children, and until recently a land-locked Washingtonian with dreams of living on the ocean. I'm also a Luddite and an unapologetic introvert. But I'm going to give you, my family and friends, and this blog my best attempt at sharing my experiences here in Gisborne.
Jesse Irwin

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