An overstayer who has had a stroke and is paralysed has exposed questions about who pays for the treatment of patients who are ineligible for publicly-funded heatlhcare.
Photo: 123rf
Chinese woman Jing, whose left side is paralysed, appreciates the care she's received in Middlemore Hospital but says she has no means to pay for it. A doctor says her case - and others like her - should be dealt with at a national level.
She came to New Zealand on a three-month visitor visa July last year, and overstayed to work as a casual cleaner in Auckland. She was planning to go home to northeast China early this year but the Covid pandemic took hold in the country and spread around the world.
Late in October, she felt sick after dinner. Her words have been translated.
"I sat there patting on my shoulders, then all of a sudden I kneeled down on the floor - my legs were weak. I couldn't stand up at all. Then I threw up in the rubbish bin."
She was taken to Middlemore Hospital by ambulance and doctors told her that it was a haemorrhagic stroke that left the left side of her body paralysed.
In Middlemore since then, 58-year-old Jing said staff have been taking good care of her.
"After washing my hair, they would help me with combing, brushing my teeth... I can't thank them enough. I use my mobile to translate and told them that it's a real pleasure to have come across them...they asked me not to worry about the bills but focus on recovering."
She said her treatment has incurred a bill of more than $50,000 and everyday the cost keeps accumulating, but she has no money to pay for it, nor does her only daughter Tian in China.
Tian said she was wanting to raise money from relatives and friends but everyone seemed to be struggling amid the pandemic.
"I also want to raise as much money and send it to the hospital to reduce any burden my mum has caused to them, but I didn't get any money."
She said she can't do anything but check on her mother through WeChat social media messages every day.
She said the hospital told her that the current plan is to keep treating her mother until she's able to wheel herself to a seat on the plane and move herself to an emergency exit should anything happen.
"I hope my mum can meet the requirements of the airline companies and come back as soon as she can. Though we don't have much money in China, we can look after her," Tian said.
"People in a foreign country is taking good care of my mother. I'm really appreciative...We owe a lot to the hospital."
The hospital declined to comment on Jing's case citing privacy and safety reasons, despite a privacy waiver.
It said it will provide urgent healthcare immediately and in a compassionate manner even if a patient is ineligible. Patients are given options for payment plans, but after 90 days, if there hasn't been a response from a patient, debts are written off and referred to a debt collection agency.
Counties Manukau District Health Board has written off more than $31 million in total in the past six years (2014-2020), with the Ministry of Health help paying a portion of the bad debt each year.
The ministry said in a statement that it recognises bad debts can arise, as some patients aren't in a position to pay or can't be traced.
"Government funding of DHBs recognises the fact that a few DHBs incur bad debts at a relatively higher level than others, and funding is adjusted to compensate them for their higher than average costs," the statement said.
Senior lecturer at the Department of Primary Health Care and General Practice of the University of Otago, Dr Ben Gray, who also does work in medical ethics, said it's inevitable that hospitals will be treating ineligible patients.
"If all of those costs come out of the Counties Manukau DHB budget rather than being funded nationally, it means that the people from Counties Manukau are effectively getting less health care for their DHB than a DHB which does not have visitors so frequently."
He says though the problem might be less obvious with borders shut, it needs to be tackled from a national level.
"I think it would be good for us to have a clear policy with a budget allocated to it to provide for essential care for people who are in the country without eligibilities for free healthcare, so that it's understood by everyone what the limits of that might be and within the limits agreed by such a policy that the government should fund all of those costs."
Figures from the Ministry of Health show close to $18 million of bad debt has been incurred by ineligible patients at the country's 20 DHBs in the year 2019 to 2020, with Counties Manukau ranking at the top, followed by Auckland DHB, Southern DHB and Waitemata DHB.
Immigration New Zealand said it's aware of Jing's case and is working on it with other agencies, but said it's unable to comment on details.