Thursday, March 5, 2009

Turkeys beg for Xmas to be cancelled. Updated with some shocking info from Mac Doc

"The free service was budgeted to cost $8.9 million extra a year when it was introduced in 2004.
But physiotherapy costs had gone from $58 million a year then to a projected $139 million this financial year.
Dr Smith said these costs were expected to increase further, to $225 million by 2011/12."
Link

Physiotherapists have started screeching, and who can blame them. They have been laying under an open cash spigot since the Labour prefects turned it on full and ripped the handle off.
Barnsley Bill regularly rolls an ankle, I have given up on the physio. Each time it happened the doc would refer me and the local physio would tell me that I need at least 20 visits... Bullshit.
TV ONE news at 4.30 have quoted them as demanding a meeting with the minister.

Sorry about the font and layout outrage. Blogger is sulking..

JC has quoted a very good post from Mac Doc and Adolf kindly sent me the link. He articulates the problem with ACC perfectly. A combination of systemic stupidity and medical proffessionals doing what any of us would do.. Milk it for all it is worth.

19 comments:

JC said...

Curiously enough, MacDoctor covered this very point back in early Dec.

"The tale of the $1000 ankle sprain

Mr. X hobbles into an A&M clinic at 7pm on a Sunday night. He twisted his ankle playing soccer the previous day and it is still quite swollen and painful. His job involves standing all day and his main motivation for attending is to get a few days off work.

He fills in an ACC form - I am reliably informed that for the form to be processed, assessed, the claim accepted and a case manager assigned costs ACC about $300 - I presume this is an average figure (i.e. this particular form may cost less)

He sees a triage nurse then a doctor - ACC is charged $38 for this.

The doctor orders an Xray of the ankle and foot - ACC is charged $112

There is no fracture but the doctor decides the sprain should be immobilized for a few weeks - he wants to use a simple air-splint for this but ACC won’t pay the $60 fee unless it is prescribed by a specialist. Accordingly, he sends a referral to the specialist and, in the meantime uses a back slab of plaster of paris to immobilize the ankle - ACC is charged $143 for the temporary back slab and loan of crutches.

The doctor refers Mr. X for physiotherapy - ACC is billed $390 ($39 per session x 10)

Mr. X. sees a specialist - ACC is billed $78 and $60 for the air-splint

Mr X. returns to the A&M to have his back slab taken off - ACC is billed $38

Total ACC cost for Mr. X and his moderately sprained ankle = $1,159

A sprained ankle is the second commonest injury to present to an A&M or ED (cut finger is the most common). I have used a worst case scenario here so the average sprained ankle will be less than this (I estimate about $650 on average). My point here is that the vast majority of ankle sprains do not require any of this intervention. If you can walk around on the ankle and the pain is improving slowly (it can be really painful for the first couple of days), the chances are that you need nothing but a couple of paracetamol and some ice. Unfortunately there is no incentive not to have all this unnecessary treatment.

* The patient pays little (or nothing in an ED) of the bill
* The doctor will get endless paperwork to do if he misses even the smallest fracture - so he will Xray almost everything.
* In an A&M, the doctors are encouraged to Xray, as the radiologist makes more money and is therefore unlikely to shut down (which would shut down the A&M)
* Most injuries ACC pays for are fairly trivial and are simply not worth checking up on.
* ACC provides more than half of the income of A&Ms - there is every incentive for private clinics and GPs to over-treat their patients.

And this is only one of the many reasons why ACC is $2.5 billion short. At least $2.5 billion…"

Barnsley Bill said...

Thanks JC, help me out here. If you can leave a link to that post in comments...I will update the post with the link pointing people at Mac Docs thoughts.

mojo said...

& of those other 'pricks' that can effectively deal to sprains & 'bad at mathematics' at the same time ... those folk who have rejected the emphatic pushing of pins in to effigies of others & instead stick 'em in real people ... those ACC funded acupuncturists in our midst. I guess the Key to the perpetuity of such is a 'free trade' deal. We accept their myths & libido enhancers, they accept our 'mal...amine' enhanced milk, I guess.

'Tis all beyond me ... I really thought there was more basis in reality for physio, especially for the indolent,albeit horribly abused, than 'needles along a meridian.'

Barnsley Bill said...

Thanks JC and AF, updated now.

Psycho Milt said...

I noticed on the news just now the Physios are saying it's important the treatments they offer should be "free." Er, hello? If you're billing for it, how exactly is it "free?"

Barnsley Bill said...

Exactly. This is woolly headed bollocks by labour exploited by businesses. Both are at fault.

Anonymous said...

You're all missing the point.

It's not about "Fraud" - NZ has very little fraud.
It's not about "Waste" - in fact, NZ govt and bureaucracy is very efficient in international terms. Go to the UK, to US, to Aussie even you don't believe me.
It's not even about "Labour party / Union rorting" although of the three, this is the most pervasive and most extensive.

It's about the simple fact that it is not mathematically possible to ensure an entire country against accident. ACC, like so much else in NZ, is a socialist pipe-dream, no more and no less.

The solution is simple: remove ACC, abolish all the legislation except the clause that prevents people suing. Accidents happen. People should take personal responsibility for what happens to them: beginning and end of the matter.

JC said...

On Tuesday, the missus and I attended a expo of aids available to people with diabilities.. all or most available to people under ACC. These gadgets ranged up to $20-30,000.

We came away with dozens of blurbs for the most ingenious products.. interestingly most not freely available to people rendered helpless by sickness and long term disease.. only to people who got pissed and drove into another car.

OK, I'm exaggerating that last bit, but distressingly not by much.

If you have an accident and end up in a wheelchair, then you can be funded into a disability wagon worth $100,000 by ACC.
If you are permanently in a wheelchair from multiple sclerosis, you sell your house to buy the wagon.

I could go on but you get the picture. There are tens of thousands out there stricken with a life sentence of disease, wheelchairs and total paralysis with little help from the State while ACC has developed into a fetish and orgy of spending for accident victims, most of whom get better.
ACC left the realms of medicine years ago and is now simply a political vanity project.. something to pull out and skite about whilst ignoring the growing problems faced in disease and age and waiting lists.

JC

Barnsley Bill said...

You have added to the quality of this post TWICE now JC. Thanks very much.

Faversham said...

If ACC is abolished the right to sue must be reinstigated immediately.

Anonymous said...

Physiotherapy and Chiropratic are the big rorts of ACC.

Physiotherapists have grown like weeds in the last 10 years. I imagine Chiropratics are the same if mine is anything to go by.

If I go to him for a "tune up", the first question is "but SMTTC what was the event which caused you to come to see me?" When I say that there wasn't any accident and I just want a tune up, it is like "well if you cannot tell me what the injury by accident was then how am I going to get you to fill in the ACC form?".

Of course, his anxiety goes away when I say I am quite happy to actually pay for his services.

Barnsley Bill said...

I have tried to avoid mentioning chiropractors because they enrage me.
They are the farking scientologists of the medical profession with their self justifying video and stupid little clicky machine. You can bet they all have a gimp room out the back where they go and whack off over pictures of L Ron Hubbard and the midget actor.
Mystical quackery.

Anonymous said...

If ACC is abolished the right to sue must be reinstigated immediately.

No! NO! NO!!!

This is the one good thing about the system: honest employers cannot get sued by budging whinging unionist workers who think it's the employers fault.

And I know the employers should lose the cases, but they still have to hire lawyers and defend themselves.

What we want is simple: personal responsibility. You get injured or have an accident or play rugby or get hit crossing a road or in your car or at work ... its your fault: you're responsibile end of story.

It's time NZ stopped trying to blame other people or the government for the mess they were in - and started looking after themselves.

Anonymous said...

I bust my ankle,beaucoup pain, went to the quack, xray confirms why said foot is hanging at very unusual angle. Lower leg is lashed in blue plaster of paris, I adapt to 6 weeks of gimping life. The cast finally comes off and I am gingerly recovering former use. So far its all normal. Then I commence a physio regime of multiple visits involving limbering exercises and little wurlitzer machines giving the joint an electrical rev-up. Ankle swells and hurts after each visit. I query the physio about the number of visits required, she says until the results are satisfactory. I miss an appointment and the ankle doesn't hurt. I miss more appointments and the joint gets better. I decide to flag them altogether and send a letter to ACC telling them my Family/Whanau Plan for Getting Back to Work [which being self employed, I never stopped], is to ignore ACC and their gravy train
of gibbons in white coats and get on with life as I know it. Indignant 'case manager' phones me and informs me I am 'entitled' to all this care. I tell her she is very kind but I don't want to hear from her again. My place in the clinic's plan for financial prosperity is taken up by mobs of yobs with skateboarding injuries, skiers and snowboarders.

My firm belief is the physiotherapy actually hindered the healing and helped the physiotherapist.

In other words, another rort.

George

Anonymous said...

Indignant 'case manager' phones me and informs me I am 'entitled' to all this care

Look on the bright side: She'll be on the dole queue (with no dole) soon enough.

NZ is the only country in the world with socialist no-fault accident compensation scheme. Every other country considering tort reform is going for the system I'm outlining:

Close ACC. Abolish the right to sue

Establish personal responsibility.
Those who choose to make take out private insurance. Those who choose not to can self-insure. Plain and simple - and absolutely no costs on taxpayers, ratepayers, and most of all employers

Socrates said...

"remove ACC, abolish all the legislation except the clause that prevents people suing. Accidents happen. People should take personal responsibility for what happens to them"

If you want a system based on personal responsibility, then you need a legislative framework where when personal responsibility is abrogated those who have a proven case may take legal remedies. Your position is wrong because it removes legal avenues for redress.

Good employers would take insurance themselves. And disputes over who is in the wrong should go to court.

But then I don’t think you are really interested in a society bound by the rule of law, just the rule of money makes right.

Anonymous said...

If you want a system based on personal responsibility, then you need a legislative framework where when personal responsibility is abrogated those who have a proven case may take legal remedies. Your position is wrong because it removes legal avenues for redress.


In civil cases, sure. But work work accidents, other accidents, medical misadventure etc? I remove no remedies that have not already been removed in NZ. All I remove is compensation for whingers and bludgers - coverage paid for by honest employers and taxpayers. And I also remove a huge incentive to dishonesty, corruption and fraud.

Good employers would take insurance themselves. And disputes over who is in the wrong should go to court.

Good employers should not need insurance. More to the point, they should not need to go to court to defend themselves from very many spurious lawsuits. What you advocate will end up like employment law with the "good faith" provisions, or like a rough version of the current system: Why pay 10,000 to defend a case why you could just pay 5,000 to the worker who "accidently" injured themselves and make the problem go away.

Read Patrick Atiyah's "The Damages Lottery" - this is his proposal after all: no torts, no right to sue, individuals can take their own insurance. If you retain the health system (I do not, but that's really s separate argument) then, at least in NZ, no-one should have a worse health outcome even without insurance: you'd just go to your public hospital with much less bureaucracy rather than go through the ACC bureaucracy to a private provider.

Atiyah's point - and the reason the unions introduce ACC in the first place - is that often the person at fault - a small business say, simply cannot pay the costs for an unforseen accident.
Bankrupting an employer who has no insurance (or another worker who pushed you into the machine)
provides you absolutely no compensation. The right to sue will only encourage unionism and vexations lawsuits against employers.


Read Atiyah's Accidents for why torts, as currently practiced are inefficient and iniquitous. But don't read Accidents for where he proposes an ACC for the UK: he changed his mind, wrote "Lottery" instead, advocating for tort abolition for accident and misadventure.

Socrates said...

“I remove no remedies that have not already been removed in NZ.”
Wrong. Remedies are currently available through ACC, by removing ACC and not re-instating the right to sue you remove ALL remedies.
“More to the point, they should not need to go to court to defend themselves from very many spurious lawsuits.”
You assume that all claims are spurious… You also assume that all employers are good and right which is just much a load of BullSh*t that the unionist spout, when they munch on about all employers are bad, all employees are good. The truth is that there are bad elements in both camps, and any legislative framework should be based on the proposition that it ensures that remedies are available for those who encounter the bad.
“Good employers should not need insurance… individuals can take their own insurance.”
Why should employers be exempt for needing insurance when individuals (who are taxpayers) should? Why should the individual when entering private property bare ALL the responsibility for any event taking place on that property rather than the owner? Especially if the owner has invited the individual onto the property (to work or procure a service)?

Clunking Fist said...

"Good employers should not need insurance."

Yeah, but good businesses wil always HAVE insurance, anonutbar. Insurance/legal remidy seems to work okay in the US of A.