Table 2.

National Health Policies Addressing Access to Care

A. General policies
Aotearoa/New Zealand	United States
Public system: 80% of total health expenditures⁸⁶ All citizens and permanent residents can access publicly funded health and disability services for preventive, inpatient and outpatient hospital services, primary care, prescription drugs in national formulary, mental healthcare, dental care for schoolchildren, home support services and long-term residential care for older adults, hospice, and disability support Out-of-pocket payment Co-payments for general practitioners (GPs) and nursing services in GP clinics Co-payments for first 20 prescriptions per family per year ($NZ5.00 per item) Primary care 13 years and under - free Others - 98% are subsidized in Primary Health Organisations (PHO) National requirements for publicly funded services for the 20 District Health Boards (DHBs) Annual budget and benefit package determined by political priorities and health needs Rationing and prioritization for nonurgent services Privately funded - 20% of total health expenditures Out-of-pocket payment - 12.6% of total health expenditures⁷⁹ Private insurance Levies for no-fault injury compensation scheme Private insurance - 35% of all adults, fewer Māori and Pacific adults (adjusted rate ratios 0.5 and 0.6, respectively); 28% of all children age 0–14 years, fewer Māori and Pacific children (adjusted rate ratios 0.4 and 0.5, respectively)¹⁸⁰ 5% of total health expenditures Cost-sharing Elective surgery in private hospitals Private outpatient specialist consultations Faster access to nonurgent treatment	Public insurance - Approximately 50% of total health expenditures;¹⁸¹ 37% of residents⁸⁰ Medicare (65 yrs and older; end-stage renal disease) - 16% Medicaid (poor, disabled) - 20% Direct purchase - 16% Military - 4.7% Privately funded - Approximately 50% of total health expenditures Private voluntary health insurance, mostly employer-based - 67% of residents 2016 – 8.6% uninsured 2010 Affordable Care Act¹⁸² Medicaid expansion determined by states (33 states and District of Columbia have expanded) 90% subsidy by federal government Insurance exchanges for those not qualifying for Medicaid- subsidized premiums Individual mandate - requirement to buy health insurance (repealed in 2017) 10 essential health benefits coverage required (e.g. ambulatory / outpatient services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance use disorder services, prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; pediatric services, including oral and vision care.) Insurance variables Co-payments Deductibles High-deductible health plans; health savings accounts Tiered drug prescription formularies - Differential pricing of generic and brand-name drugs Value-based insurance design Better coverage of more effective treatments Federal and state workmen’s compensation laws Tort system for injuries
No fault Accident Compensation Corporation: Universal coverage for acciental injuries including treatment costs and 80% of pre-injury earnings

B. Equity-specific policies
Aotearoa/New Zealand	United States
Patient co-payments capped ($NZ17.50) in low-income areas (1/3 Aotearoa/NZ)	Federally-qualified health centers Public hospitals Local health departments Free clinics Disproportionate share hospital payments for uncompensated care Charity care - private providers