ACC is the "Accident Compensation Corporation". It is a "scheme" (which in New Zealand has no sinister connotations, but rather means "an organization") that provides no-fault insurance coverage to all permanent residents of New Zealand for any accident, pretty much regardless of the cause. In return for this extensive coverage, in New Zealand law there is no provision to sue for personal injury, other than for "exemplary damages". To quote their web page:
The scheme:
• provides cover for injuries, no matter who is at fault
• eliminates the slow, costly and wasteful process of using the courts for each injury
• reduces personal, physical and emotional suffering by providing timely care and rehabilitation that gets people back to work or independence as soon as possible
• minimises personal financial loss by paying weekly earnings compensation to injured people who are off work
• focuses on reducing the causes of these problems – the circumstances that lead to accidents at work, at home, on the road and elsewhere
To emphasize how different this system is, let me make a few points. Unlike "Worker's Compensation" in the U.S. and other countries, ACC covers any accident, anywhere, whether the injured person is employed or not. This means it covers auto accidents, injuries to single mum's who are unemployed, schoolchildren on the playing fields, and even foreign tourists who are hurt in New Zealand. Because it is" no-fault", ACC's only concern is to be sure that the injury was truly accidental and not a form of illness- and even then it will cover an illness aquired at work, such leptospirosis in a dairy worker.
The same company that is paying the bills for injuries and accidents is also charged with ensuring worker's and citizen's safety from accidents. Thus we see wonderfully shocking public service announcements on television. In 15-second shots interspersed between other commercials, a dropped cigarette burns down a child-filled house over the 3 minutes of the commercial break. Or the anti-speeding ad, which shows two cars crashing into a lorry, the car going 5 kph over the speed limit being totally demolished compared to the law-abiding driver's car which has a slight fender bender. Or, most painful to watch, ads that seem like they are selling house paint, or cleaning products, only to have the actors take tremendous falls down stairs and off ladders. And my personal favorite, 2 minutes of progessively more and more serious car crashes in intersections, to the tune of "Don't Worry/Be Happy!". ACC even pays for the bus and part of a program helping police keep drink drivers off the roads here.
Additionally, once patients enter treatment, ACC is committed to having doctors follow the best evidence for rehabilitation and treatment. Thus, in only 5 months here, I have received in-service material that includes evidence-based guidelines for treating back injuries, complete with a kit of patient education materials; a one-hour visit from the local ACC health educator who talked to us about the best ways to obtain services for occupational hearing-loss and sexual abuse/rape patients, and a providers handbook with more resources and references than I've had time to read. ACC also has a phone hotline that I've used a few times to facilitate referrals or entry into rehabilitation services under special case management.
Malpractice is also covered by ACC. In fact, its not even called malpractice here anymore. It's now "medical misadventure". Recent changes in the name and administration of medical accidents make New Zealand a world leader in preventing malpractice. As outlined in "To Err is Human", medical accidents are inevitable. The no-fault system supports the principles of error recognition and management outlined in that report, and currently used in the airline industry. If I discover a medical misadventure, I can open an ACC claim, and the patient will receive accident compensation and medical insurance to correct the problem. Furthermore, ACC will use the report data in its ongoing efforts to prevent errors, just as it uses accident data from other industries in accident prevention programs. The report is not automatically shunted through the medical disciplinary board, and the patient does not have to prove medical "negligence" to get some help. Also, doctors are more likely to report colleagues errors when they know the report is not going to automatically generate a suit.
There are a few downsides to the system. There is paperwork to do for every accident; even a sandfly bite or a foreign body in the eye requires some forms to be completed. But I am getting pretty good at finding the Read codes for injuries on cheat sheets, and I can file and sign a claim in less than 1 minute now. Eventually I expect this will be done electronically as part of our office computer system here. And overall I think I've probably less time here doing ACC forms than I would have spent composing letters to lawyers, employers and insurance companies in the U.S. The system does consume quite a bit of money, but since any society is paying for the accidents one way or another (in lost productivity, medical expenses, legal fees and court time, etc) the estimated NZ$9 billion in future liability in the system just makes the cost more easily visible. Patients who use the system report an 86% satisfaction rate, and ACC has its own internal auditing, quality improvement and dispute resolution programs which contribute to this.
I won't hold my breath that something like this will ever happen in the United States. For one thing, the country with the most lawyers in the world would never stand for abriging the rights of anyone to sue. And I despair that the public would accept true equality for all accidents. By this I mean the concept, that if you're injured, you are paid standard amounts of disability compensation, based on your previous earnings, and not on "pain and suffering". In New Zealand, if you do not hold a job at the time of your injury, you receive only the basic "Benefit". It is clear to me that we in the U.S. pay a very large price for our cultural support of "victimization", where anyone who gets a bad break in life is victim of some injustice. Sometimes bad things just happen in life. I have felt comfortable practicing under the ACC scheme. Every day I'm glad that my patients- especially working farmers- aren't going to be wiped out by an injury. Losing the "right to sue" for damages seems a small price to pay for the benefits this scheme provides. Instead of a "right to get revenge" via lawsuit, ACC substitutes a "right to be cared for and compensated". Its cheaper, its better, and its a lesson we Americans need to take to heart in these times, when its clear revenge does not work.
