Intergenerational conflict – is it inevitable?

The world has woken up to population ageing as a major issue, but it still tends to be seen as something negative. Terms such as ‘age-quake’, “cataclysm”, “threat, ‘burden’ and ‘grey tsunami’ are bandied about. One journalist said:

The ramifications (of ageing) could be serious as the elderly become an additional burden to the traditional scourges of poverty and disease.

It sounds scary – as if poverty and disease (and not forgetting climate change) were not enough, now we have old people as part of the apocalypse. The implication is that older people are going to eat up more than their fair share of resources, thus depriving oncoming generations. The scene is set for conflict and competition between the generations. Intergenerational solidarity, which was in one of my blogs in early 2013, is under threat.

Younger workers, it is argued, face a large and growing tax burden to pay for superannuation and health care. Although reforms in many developed countries have slowed the growth of expenditure, age-related costs are projected to grow faster than national income in the next few decades.

The New Zealand Treasury expects that, by 2060, there will be four people aged 65 plus for every ten aged between 15 and 64, which is the usual definition of “working age”. That ratio compares with two to ten today. Bringing in dependent children under the age of 15, demographers expect that there will be seven “non-workers” to every ten people aged 15 to 64.  Of course, 15 to 64 is not a realistic “working age group” even now, when the school leaving age is 16, much less in forty years’ time, when workforce participation after age 65 will certainly have grown. But the point is worth considering.

New Zealand Superannuation spending is almost 5% of GDP (Gross National Income) now. This percentage is expected to reach 7-8% by 2060, depending on which estimate you choose. The same kind of increase is projected for health service spending, including residential care. Put another way, today, around 25% of the government’s annual spending goes on services for 13% of the population which is aged 65 plus.  By mid-century, 40% of spending may be for this group, which will then account for 25% of the population.

These estimates raise important questions, especially about inter-generational equity. New Zealand compares favourably with other OECD countries in combating poverty among older people, but our poverty rate among children is higher than the OECD average. How can we reach a balance? How do we make the right choices for the future?

Political and journalistic rhetoric tends to pit the generations against each other, pointing out the growing tax burden and an unenviable legacy of mounting debt or higher taxes.

Perhaps we should think about more intra-generational sharing of the costs of an ageing population. Could the wealthy, younger retired contribute more to the costs of care for the older, low-income and often less healthy, retired? By doing so, the pressure on the working age population could be reduced and intergenerational equity enhanced.

While the very old will continue to need care services, should we think about how the costs of care be shared more equitably? Could advances in information and communication technology help to keep people in their own homes longer, with a mix of family, commercial, voluntary and public sector support?

How can governments maintain income support to provide a good quality of life in retirement without jeopardising financial sustainability? A key solution is longer working lives. Half of the OECD countries are already increasing pension eligibility ages or will do so in the coming years, this being a powerful way to encourage longer working lives (as was the case when eligibility for NZ Superannuation was raised from 60 to 65). Around half of OECD countries’ pension reforms involve greater targeting. How would we react to moving away from the universality of New Zealand Superannuation?

 Our policies should aim to ensure adequate income, health care and support for caregivers across the generations. Older people have an interest in seeing that all children are given good education and health care as this will impact on the society in which their grandchildren will live. Young people have an interest in the availability of good care for their own parents and grandparents.

Policies work in a multi-generational context. We pay taxes to support older people’s superannuation and healthcare costs, but also education systems and maternity services. Governments invest in roads and electricity supply, economic development, job promotion and environmental protection, which help everyone. This works well when the age groups are balanced. This balance looks likely to disappear in future.

There are certainly challenges, but is intergenerational conflict inevitable? May it be more in the mind than in reality? A large-scale survey in OECD countries asked, “Are older people a burden on society?”[1] 85% of people strongly disagreed or somewhat disagreed with the question. Interestingly, it was people aged 55 and over who were most likely to agree!! But this study did not find that conflict between the generations was increasing. The authors concluded that intergenerational conflict is weaker when older people actively participate in the political life and are visible in society. This suggests that policies to promote Active Aging could mitigate intergenerational conflict.

One of our few growing natural resources is older people. How can we provide opportunities for them to make a greater contribution? How can we combat ageism which acts as an obstacle to this aspiration? Action is urgently needed to ensure a fairer re-distribution of resources, responsibility and participation and to develop greater cooperation between generations in all social and economic spheres.

 

 

 

[1] Hess, M, Nauman, E. and Steinkopf, L. (2017) Population Ageing, the Intergenerational Conflict, and Active Ageing Policies – a Multilevel Study of 27 European Countries. Journal of Population ageing. Vol.10, Issue 1, P.11-23.

 

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Home ownership as a status symbol for older people

When social researchers and policy people want to examine trends in their relevant populations they often “dissagregate”, that is separate out groups of people by their characteristics. Thus, we are used to totals by gender, by ethnicity, by age and by socio-economic status. None of these characteristics is clear-cut. You may have noticed that as well as male and female there is often another choice, such as “gender diverse”. Many people have affiliations to more than one ethnic group – so how can we be sure about the proportions of Maori, Pakeha/European and so on.

But, despite this, there are a lot of links between certain population groups and their general experiences, such as health status. Women tend to live longer than men. Maori are more likely to suffer from cardiovascular disease than Pakeha. These differences have significance for policy and service development.

A characteristic which plays a large part in social analysis and which has significant policy implications is socio-economic status (SES) or socio-economic position (SEP), sometimes called class or social advantage/disadvantage. The most commonly used indicators for studying SES are income, occupation and educational qualifications. For example, NZDep is a national index derived from census data, and has indicators of income, employment, education, home ownership, household overcrowding, transport, support and telecommunications. It is applied to geographical areas and is used to pinpoint levels of social deprivation, hence special funding for schools and other services.

But how can the SES of older people (65 plus) be measured when they are no longer in paid work, and who may have their income fixed by national policies? This is a key question which Associate Professor Daniel Exeter and his team at the University of Auckland are exploring as part of their Marsden-Funded project. Older populations are likely to have received limited secondary and tertiary education. The applicability of the usual indicators decreases with age. For example, instead of current occupation, sometimes “last occupation prior to retirement” is used in SES measurements. But this may not be a correct representation of an individual’s main occupational status through life. Prior to full retirement, many older people have less demanding jobs as transitional or as supplementary to a retirement lifestyle.

Is housing tenure a good indicator of socio-economic status?

In her Master’s thesis, Olivia Heatley, one of the Auckland team (supervised by Daniel Exeter and Dr Nichola Shackleton), addresses this question and concludes – “Current measures designed for working age populations do not accurately reflect the position of those adults aged ≥65.”[1] The aim of her thesis was to create a census-based measure of SES in older people in New Zealand and hence to provide a means to help target the distribution of resources to vulnerable older groups – a growing policy challenge as the population ages.

After pointing out how other SES measures may be less appropriate for older people, Olivia discusses using housing tenure. It is regularly collected in major surveys which cover the vast majority of the population.[2] Funds tied up in housing are likely to make up a sizeable proportion of older people’s assets (if not their only asset). As such, they can be a measure of accumulated wealth and can illustrate the cumulative advantage or disadvantage individuals have experienced over time. Research results show that house value is highly associated current health status.

“Housing tenure provides one of the most fundamental bases of financial and social well-being in old age” (Kendig, 1984).

A measure of SES in older people based on housing tenure should distinguish between outright homeowners and those with a mortgage. Mortgage free status brings the benefit of much reduced housing costs. Older people with a mortgage-free home are more likely to find NZS payments sufficient for their weekly expenses.  There also needs to be a distinction between owners and renters (private and public rental accommodation). The ownership of a private dwelling is likely to reflect higher levels of education and income than the situation of those who are still making substantial rental (or mortgage) payments.

A SES (SEP) measure for the older population
Olivia’s research provides a new measure of socio-economic position, dividing the ≥65 population (excluding those in non-private dwellings) into three distinct groups: low, medium and high socioeconomic position (SEP).

Low SEP – The main marker of low SEP is living in public rental accommodation, but also people renting privately and owning a home with a mortgage.

Medium SEP – Represents those who may not be wealthy but are still in a stable financial position. They may still be homeowners with a mortgage or renters, but a series of further financial indicators must come into the assessment.

High SEP – The main marker of high SEP is a mortgage free home. Literature surrounding housing tenure and owner occupation consistently shows better health outcomes for those who own their home compared to other tenure arrangements.

On this basis, 20% of older people can be classified as in low SEP; 59% in medium SEP; 22 % in high SEP. This is a very simplified outline of the proposal but does suggest the importance of housing tenure to the wellbeing of the older population.

As part of the Marsden Funded project, the Auckland team are producing a preliminary Older People’s Index of Multiple Deprivation (OPIMD) which uses 15 indicators of deprivation reflecting the social conditions of the 65 plus population.

[1] Healey, O. R. (2018). The Forgotten Generation: Creating a census-based measure of socioeconomic position (SEP) for the ≥65 population The University of Auckland. ResearchSpace@Auckland.

[2] It does, however, exclude older people living in institutional care.

 

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Older People and Kiwi Saver

2019 Review of Retirement Income Policy

The review’s terms of reference make several references to KiwiSaver. Given the growing number of older people and longer lives, KiwiSaver is (and will be) an important part of retirement income plans.

The review was asked to assess what impact KiwiSaver (KS) would have on retirement income policies, along with the public’s perception and understanding of KiwiSaver fees, their levels and types and the range of KiwiSaver funds available.

Some light in these issues comes from a survey carried out by the Commission for Financial Capability (CFFC) in April 2019. This included a sample of 2000 people and asked them the reasons why they were not in KS. The oldest age group covered was 50-65 – people coming up to the, then, age cut-off (65) for KS membership. The answers for this age group were –

Have other savings/investments that will secure a comfortable retirement:  28.9%*

Can’t afford it:  24.5%*

Afraid Government will change the rules to the disadvantage of KiwiSaver members:      13.3%

Fees are too high: 6.4%

People aged 50-65 gave the highest percentages for these four reasons. The reasons marked * were the leading ones for all age groups, excluding people who had no income or who had never been employed.

People in younger age groups were more likely to say that they didn’t feel comfortable with the risk inherent in KS. Overall a quarter of the respondents had some fears about the future of the scheme and the risks involved. And 20%, mainly in the younger age groups, felt that they did not know enough about KS.

2019 Changes

Ahead of the outcomes of the review, some changes to KS, which affect older people, came into effect on July 1th. From this date people aged 60 plus became eligible to join or to continue in KS, but employer contributions were not compulsory for them (although it appears the majority of employers are making these contributions). People who join KS aged between 60 and 65 are no longer locked into the scheme for five years but can still withdraw their funds at 65.[1] These changes, and other commentaries on the policy review, recognise growing paid workforce participation by people aged 65 plus.

 Choices to make when KS schemes mature

People reaching age 65 can now decide whether to take their KS lump sum then and reinvest elsewhere or remain in the scheme and continue to contribute to increase their final draw down. The details of post-65 arrangements will vary by KS provider.

“Smart Investor” (https://smartinvestor.sorted.org.nz/) compares the percentage costs between KiwiSaver and other managed funds

Type of scheme          KiwiSaver highest    Other managed funds highest

Conservative                           1.65%                          2.43%

Balanced                                 2.60%                          3.49%

Growth                                    2.23%                          4.36%

This may be a rough and generalised comparison, but it appears to show that KS schemes have lower costs than other managed funds, and, thus, there are advantages for older people to remain in KS after age 65. The commentators suggest that the over-65s had been stuck with higher-priced options by being excluded from KiwiSaver (depending on the individual fund chosen).

Prospects for Retirement Incomes

At the Retirement Policy Research Centre’s “Summit” in Auckland in April, as well as the contributors I have quoted from above, Alex McKenzie from the MSD gave his views on present and future prospects. [2]

He concluded that older New Zealanders are currently doing relatively well, with low rates of income poverty and material hardship relative to other age groups; high rates of home ownership; and a growing economic contribution (as workers, volunteers, taxpayers, investors and consumers). KS is an excellent mechanism for saving, but its impact on future retirement incomes is uncertain. Those that will really need it are probably less likely to be saving, or not saving sufficient.

He pointed out emerging trends that point towards a future with an increasing number of older people who may not be doing so well. Trends point towards a future where the rate of income poverty and material hardship amongst older New Zealanders may be higher than they are now, with the great majority very dependent on NZS and other government transfers for their income, especially if they are not part of KS schemes.

People now in their 50s and early 60s experiencing poor health, financial hardship, poor or inappropriate housing and social isolation, have poor prospects for their older years. He suggests that housing will be a key driver. Those without a mortgage-free home will face an increased likelihood of having an inadequate income (after housing costs). People now aged 45 to 64, living on their own, have the second highest rate of income poverty after sole parents. This percentage has grown from 10% in 1988 to 23% in the early 2000s and is now 29%.

This all suggests that more and more people will need to work beyond pension age, despite a number of barriers, including negative attitudes from some employers and others and the possibility of increasing health issues. What are the implications for the role of KiwiSaver?

 

[1] Troy Churton – Ageing workers, workplace participation and KiwiSaver, RPRC PPI Summit: 2019 Retirement Income Policy Review and You, proceedings.

[2] Older New Zealanders: Some Emerging Trends Alex McKenzie Ministry of Social Development RPRC Summit: The 2019 Retirement Income Policy Review & You 26 April 2019

 

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How can local authorities help older people with housing costs?

Two reports, one from the Productivity Commission and one from Local Government New Zealand, have recently looked at the functions of local government and how these might change to become more efficient and responsive to local needs[1]. This is an important question, but here I want to narrow my focus to look at local authorities in their role of assisting older people with housing costs.

The Rates Rebate Scheme (RR)

This was introduced in 1973, designed to assist low-income and older ratepayers/homeowners having difficulty with housing costs. The maximum RR is $630 a year but the amount granted

depends on income and the level of rates. A single person with New Zealand Superannuation (NZS) as their only income will be eligible for the full rebate if their total yearly rates are $1,050 or higher. A couple with only NZS will get a full rebate if their rates bill is $3,450 or higher. The RRS is not subject to an asset test.

In 2018, the Government amended the Rates Rebate Act 1973 to provide RSS eligibility for residents in licence-to-occupy retirement villages.

The number of RR recipients peaked in 2011 at over 115,000. Since then the total has declined, to 98,000 households in 2017, when 78% were households of New Zealand superannuitants. The decline is related to the fact that the income abatement threshold has not kept pace with increases in the value of NZS payments.

There are other issues which may have reduced the uptake of the RR. One is a cumbersome application process. Ratepayers must apply, generally in person, to their council to receive the rebate and submit a statutory declaration about their income and family composition (often every year). Although ratepayers apply to their local council, central government provides the rebate through the Department of Internal Affairs.

In addition, the RR provides a very small dollar amount (the maximum rate is just over $12 a week) and people on higher incomes may not bother to apply for it. There have been many calls for an increase in the rebate and for it to be indexed to inflation. It is hard to assess at any point in time just how many older people might be eligible.

Overall the RR does provide a means for older homeowners on low incomes meet their rates bills without eating too far into their day-to-day incomes. Many have large rates bills due to the rapidly increasing value of their properties. However, older mortgage-free homeowners are not the group likely to be experiencing the greatest material hardship. The rebate may be seen as inequitable as it is not available to renters who are likely to be worse off financially than homeowners. And owners have access to home equity which could be mobilised to help with housing costs.


Other ways to give assistance

 Local authorities can use other methods to help older people with housing costs. Some add to the RR, for example Kāpiti Coast District Council supplements the RR with additional assistance of up to $350 a year, targeted to the neediest ratepayers.

The Local Government Act allows local authorities to develop a rates remission policy which may waive penalties for late or non-payment of rates.

Rates postponement, under the same legislation, is when a local authority agrees to delay the date of rates payment until a specified time or a specific event occurs, such as the sale of the property. This can help ratepayers who are asset rich and cash poor. Some councils offer postponement of rates for older people if they choose to let their rates be paid out of their estate when they die, or when their property is sold. This is a form of equity release (see my blogs in mid 2014). However, councils may not be keen on this form of assistance as it delays the time when they will receive the rating funds, often by many years.

 

Can rates postponement schemes be improved?

Each council is responsible for its own rates postponement arrangements, if they have them, and these vary greatly. Financial firms have offered reverse mortgages for many years and payment of rates may have been among the uses, of the funds released. Yet the reluctance to take up reverse mortgages is at least partly due to perceived high fees and doubts about the security of the arrangements. The Commission suggests that improved arrangements on a national basis, based on similar principles, could reduce the problems and lead to greater acceptance of rates postponement.

Potential customers are likely to be more attracted to a nationally recognised product designed specifically to facilitate rates postponement and offered by a well-trusted public or private financial entity. A single provider (or a few large providers) are more likely to have sufficient scale to support moderate fees.

The Commission concludes that the RRS should be phased out. Central and local government should collaborate with suitable financial providers to develop, implement and promote an improved scheme. It will be worth following the progress (or otherwise) of this proposal.

 

 

 

 

 

 

[1] Productivity Commission, (2019) Local government funding and financing: Draft report.  Wellington. http://www.productivity.govt.nz

Local Government New Zealand (2019) Reinvigorating local democracy: The case for localising power and decision-making to councils and communities. http://www.localism.nz

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Ageing on a University Campus

26/07/2019

We have often heard praise for the benefits of intergenerational housing developments, where older people live alongside families and young workers/students. We have heard criticism of retirement villages, where older people can be cut off from younger generations. And, what about the call for life-long learning?  There is a way of addressing all these issues in one stroke.

The answer may be University-Based Retirement Communities (UBRCs).

These are housing developments which look like retirement villages – see the photo below -but which are situated on or near universities or other tertiary education establishments. There are now well over 100 UBRCs in the USA.

The characteristics which define successful UBRCs, are set out by Andrew Carle in Forbes  Magazine[1]

  • Proximity to the campus
  • A range of activities to encourage intergenerational diversity
  • Senior housing offering a continuum of care, from independent to assisted living
  • Support from alumni and employees of the university
  • Sound financial planning between a senior housing provider and the university.

The extent to which they are integrated with the university varies, but there is the opportunity for older people to have access to –

  • Well-equipped hospital facilities (for example, where there is a medical school)
  • Gyms and sporting facilities
  • Exercise and dance studios and theatre spaces
  • Education at various levels, with a wide range of subjects[2].

UBRCs can also offer opportunities for older people to volunteer, for example in coaching or mentoring students, as well as helping in libraries, etc. And, in their turn, they may be able to receive support from student volunteers or from paid services, not to mention access to food and retail outlets often found on campuses.

It becomes a symbiotic relationship — older generations are offered an opportunity to use their wisdom and experience to guide and empower youth and youth have an opportunity to expose older adults to scientific advances and novel life experiences.

Other services and opportunities provided by UBRCs in the USA include memory clinics; WiFi and free computer classes; lessons in golf, swimming and other sports from college athletes; Skype lessons from student volunteers, and multimedia journalism.

The benefits for the university include attracting a broader student base, expanding the audience for sporting and cultural events and offering internship and work experience opportunities for students studying things like gerontology, nursing, nutrition, public health management and physiotherapy. There is also the opportunity for bequests through strong links with retirees.

There are drawbacks of UBRCs. They include the cost to residents, which may be high. And the reaction from students – as outlined below.

An example from Georgia [3]

Berry College, a private liberal arts institution, with about 2,000, mostly traditional-age students, has leased land to a non-profit organisation for a retirement complex –The Spires. The college provided seed funding for the complex, which will offer independent and assisted-living housing, as well as a continuing care facility.

The Spires will house 350 seniors and will be only a short distance from the main campus. Residents will be welcome to roam the college’s grounds, hang out in the student centre, attend football games or concerts and take classes for free, space permitting.

There were concerns from Berry students at first – that it would alter campus dynamics, as though they would always be under the watchful eye of grandparents. Some squirmed at the thought of white-haired retirees filling the stands at football games or becoming fixtures on the couches in the student center.

But there are also upsides: students will be offered paid work and work experience at The Spires. Nursing majors could help the facility’s nurses; marketing and accounting majors could get practical experience. Students will have opportunities to network with residents and share real-world insights about jobs and career paths. This helped to calm most concerns.

judith housing blog

The Spires, a retirement housing complex, under construction at Berry College in Rome, Georgia. It’s scheduled to open in 2020 and many spaces are already reserved. 

UBRCs have reached Australia

Much closer to home is the development of UBRCs in Australia. There was a very recent headline in The Senior James Cook, La Trobe universities to open retirement village, aged care, on campuses.

James Cook University is planning retirement villages and an aged care facility alongside student accommodation in its Douglas campus (Townsville) and the Townsville Hospital. The 10-to-20-year project is expected to be home to 8000 residents and 1300 students.

In Melbourne, La Trobe University has plans for a $400 million healthcare hub with aged care at its Bundoora campus. This will include a 240-bed aged care facility, a 125-bed private hospital, childcare centres and clinic facilities. There are also plans for residential aged care and independent living in the development. The project will create employment and educational opportunities for students and staff as well as improved access to health services for local residents.

Could we see the major names in retirement village development in New Zealand contemplating similar developments with our universities and polytechnics (and vice versa)?

[1]Andrew CarleCan University Retirement Communities Reverse Aging? Forbes Apr 22, 2019. Carle is a healthcare and retirement/senior housing executive who was a founding director of the first UBRC.

 

[2] At Lasell Village in Maine residents are required to complete 450 hours of learning and fitness activity a year, either inside or outside the classroom.

 

[3] Matt Kempner, The Atlanta Journal-Constitution, Jun 6, 2019.

 

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Health insurance – Who is Covered ?

12/07/2019

In an earlier blog, talking about self-funding retirement income, I added insurance to cover medical costs to the ways in which individuals, rather than governments, could contribute to income adequacy. It is estimated that 1.34 million New Zealanders have health insurance – around a third of the population. We have a public health system and ACC, so what part does health insurance play? This is a question especially applicable to older people who often call on health services but who may be living on lower incomes than they previously enjoyed.

Estimating coverage with age

I set off to see how health insurance cover varied by age. And found information from the New Zealand Health Survey[1] and from the 2018 Annual Report of NZ Health Funds (health insurance providers).  These figures should be seen as tentative but give us some idea of coverage.

Health Survey Data – This recorded 35% of adults as having private health insurance, a figure which decreased from 40% in 1996/97. Coverage was highest for the age groups 35 and 64 (41-42%), and lowest for people 75 years and over (16%). And for the total aged 65 plus – 23%. After examining a range of demographic and socio-economic factors, household income was found to have the strongest association with private health insurance coverage.

Health Funds report – Coverage of the population aged 15 plus was 34.4%, similar to the Ministry of Health figure and the figure for 75 plus was the same – 16%. This source has a breakdown for the older population, which allowed me to estimate what percent of each age group was covered from age 60 onwards. As the diagram shows, this fell steadily from 30% at age 65-69 to 17% at age 80-84, 15% at 85-89 and 12% at 90-94.

judith diagram

Why the drop-off by age?

The main issue seems to be cost. There have been many recent media reports of substantial rises in health insurance premiums for older people, often amounting to 20%, based on the presumed higher risk of making claims.  For one couple in their sixties (quoted in a Stuff article by Rob Stock) their annual premium rose from $3,022 to $3,617. As a result, many retired people are opting out of health insurance –

If we ask around our circle of friends, none of them poor, I think we are the only ones with health insurance.

In another Sorted quote, a couple reported that they were paying $4800 a year for hospital/surgery cover, with an excess of $2000.

We are struggling to accept this cost, even though we can afford it. We paid for private health insurance for 20 years, only ever making very small claims. Now in our 70’s, we decided that the cost is not worth it, so we have cancelled it.

Could the costs be evened out?

House, contents and other insurances do not differentiate by age (although we all know about travel insurances), but one way to reduce health insurance costs for older people would be to even out the premiums between the age groups as is done in Australia under the “community rating” scheme. Of course, the young would pay more than they do now, but the old would pay less.[2] Could a government intervene to make the young subsidise health insurance for older people? Community rating is not unknown in New Zealand, ACC does not base levies on people’s ages.  But health insurance is driven by commercial rather than equity goals.

Weighing up the need for health insurance

Medical insurance has its advantages. A quote by an individual, from Sorted.co.nz

You don’t have to wait for public services, and you can select who you want to see if you’ve got a preference for a specialist or a surgeon. The waiting lists are so long, so you are able to have surgery done right away. And you’re not going to be waiting around in pain.

It is a question of weighing up likely risks and the costs of using medical services, where full or part costs have to be paid. We do have the public health system, and ACC for accidents. There are subsidies for GP consultations. Acute treatment and surgery will always be taken care of. But for ‘elective’ procedures, which are not deemed as urgent (and these will include joint replacement surgery and non-urgent screening), that’s where having health insurance can make a difference.

People could self-insure. Instead of paying an insurance company, health costs can be covered if and as they arise, from personal savings. Sorted recommends setting aside three months’ of expenses for an emergency fund. If saving is possible and very high cost procedures are avoided this may be a cheaper alternative to commercial insurance.

There may also be ways of saving on health insurance –

  • Opting for a higher excess
  • Comparing insurance companies for discount rates (e.g. for non-smokers)
  • Reducing the amount of coverage, say $100,000 instead of $300,000 for surgery
  • Skipping comprehensive coverage and choosing ‘hospital-only’ or ‘hospital and specialist’ policies
  • Using workplace-based health insurance plans. Some employers offer health insurance schemes to their staff. These are usually cheaper to join because employers can negotiate better group rates and offer subsidies. And rates are not based on age.

Doing my research for this post, I looked at websites of health insurance companies. They all offered free quotes. But when I put in my particulars – just to see what it might cost – I found that no new clients would be accepted beyond age 75!

 

[1] The New Zealand Health Survey used data collected between 2011 and 2015, covering people in New Zealand who reported having private health insurance, by age, sex, ethnicity, household income and other variables.

 

[2] Rob Stock article in Stuff, January 27, 2019.

 

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Valuing Carers and Providing Respite

28/06/2019

According to the 2013 census, 430,000 New Zealanders were identified as carers – 10% of the population. Each week, an average carer provides 24 – 36 hours of support, and this unpaid work is estimated to be worth $7 – $17 billion. The latter figure is more than the total health budget. It is not clear how many of these people care for older people or how many are older themselves. But many are, and the numbers are likely to grow as the population ages.

Intensive unpaid caring, especially for someone living in the same dwelling can be stressful and can threaten the health of the carer. Respite care is intended to give carers a break and a rest, for a few hours, a day, overnight or longer, either in or away from the family home. Respite helps the carer ‘recharge’ and gives the person being cared for a break.

Respite care keeps families together, keeps people out of hospital, reduces the use of funded services, delays the degeneration of people’s physical and mental well being and is, as the Carers Alliance asserts, a cost effective and societally just investment.

Respite services are accessed through local Needs Assessment Service Coordination organisations (NASC), who check eligibility and identify needs. The amount of funded respite support is based on assessed needs. There are different types of services; overnight respite is available some aged residential care facilities, or a paid worker may stay with the person needing support[1]. Those who are eligible for Carer Support/respite days, receive a list of local facilities that hold appropriate contracts. The carer can then contact a facility or organisation to discuss options. A certain number of respite days are allocated each year, and cannot be carried over

 

I Choose – a new initiative

This year the Ministry of Health is starting a more flexible type of respite support called I Choose. This will provide cash payments to carers who can use the money to buy any respite support or service, as long as it gives a break from the caring role. I Choose is called a ‘flexible respite budget’. Voucher schemes like this already operate in other countries.

Despite these changes, a new report, Respite In New Zealand: We must do better, prepared by the New Zealand Carers Alliance in association with Alzheimers NZ and IHC, documents significant problems facing the system. While supporting flexible budgets, the report calls for service improvement and innovation across the country. While calling for implementation of the I Choose framework, the report also seeks –

  • A review of how respite services are funded and commissioned. A fragmented funding environment involving multiple organisations and government agencies is creating duplication and confusion. Streamlined policy settings will help to improve the system and reduce waste.
  • Better availability of services – inequalities in DHB investment are leading to variation across the country. Many users are unable to use their full respite allocations.
  • A respite innovation fund for providers to improve respite services.
  • A cross-sector stewardship group tasked with co-ordinating a system-wide response and creating coherent policy.
  • Better quality assurance and monitoring.

 

An article in the New Zealand Medical Journal[2] concludes

If the government wishes to have more people with disabilities or chronic illness living at home, greater resources are needed to adequately support caregivers. At present this important sector of the population is undervalued and under provided for

Stop Press
A statement from the Ministry of Health, 25th June, 2019

I Choose is on hold while the Ministry of Health works on a sustainable implementation plan to ensure that disabled people and their whānau can continue to get the breaks they need.

[1] http://carers.net.nz/information/advice-give-yourself-a-break/

[2] Jorgensen, Diane ; Parsons, Matthew ; Jacobs, Stephen ; Arksey, H: (2010) New Zealand informal caregivers and their unmet needs. New Zealand Medical Journal 123(1317):9-16

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