MacDoctor March 14, 2009

ACC – The Facts

There has been a lot of activity in the blogosphere about ACC recently. Much has been written about the apparent “blowout” in ACC accounts (as if this is something new). Some right-wing bloggers have suggested legal proceedings against Michael Cullen for not revealing the extent of the current deficit, but, while he deserves some scorn for being a complete tosser, I don’t think his duplicity quite merits summary execution. Left wing blogs, notably the Standard, have tried to play up the economic crisis as the sole cause of the deficit but this will not hold water either.

PriceWaterhouseCoopers, in their latest report do suggest that the majority of the current deficit is being caused by the economic climate. This is partly true, but only in the sense that massive increases in expenditure and long-term liabilities are now not being covered off by rapid growth in ACC’s assets. 

The boys at the Standard suggest that, when the upturn comes, this gap will disappear. This is only true of very long-term liabilities where a transient drop in interest earned causes a large blow-out in estimated liabilities. However, the graph below suggests there is a much greater problem than a transient accounting glitch (you can find these graphs and tables here). First the graph:

acc_expenditure

Notice the persistent rise in costs from the time Labour excludes competition from ACC thereby making it a state monopoly again. The Standard attempts to blame these increasing costs on population growth and aging population and the obesity epidemic. Ploughing through the available population stats from 20002008 we find that the population growth was about 17%, the number of elderly as a percentage of population actually decreased (due to immigration, I assume) and about an additional 6% of the population became obese (from 20% to 26%). In the meantime, ACC expenditure doubled. Even generous weighting for the obese (no pun intended) would increase costs by less than 16% (20% of 6% x 13ACC costs for the obese are assumed to be 13 x higher). Thus the maximum increase in ACC should be 33% NOT 100%.

This table is even more revealing:

claim_liability

Notice that the blow-outs in liability started in 2002 and have been increasing rapidly ever since. The two years before the current year had liability increases of $2.6 billion each year – well before the current economic crisis. This suggests that the ACC expenditure blow-out started well before the drop in asset growth blew out the long-term liabilities. Note especially that the discount rate for 2007 and 2006 was 6.6% – denoting good returns on assets. Yet the liabilities increased by over $5 billion.

acc_assets

As at 20th February net assets were $10.124 Billion. Nick Smith was right, if ACC was a private insurer, they would be insolvent. ACC, of course, get an automatic bail-out from the tax payer. Note that the largest asset increase was $1.66 billion (2005 to 2006) but that 2006-7 was only $1.3 billion. In conjunction with a good discount rate (i.e. good rates of return), this suggests some draw-down of assets to alleviate costs. This makes the increase in liabilities for that year even more worrying. ACC was feeding off its assets.

Overall, the facts suggest that, rather than a long-term liability problem, ACC has a short term expenditure problem. Clearly, ACC is picking up short term and long term liabilities at an alarming rate.  The causes of this can only be the changes made by Labour during the course of their tenure.

  1. Physiotherapy: I have discussed this here. Current cost $139 million.
  2. Change from medical misadventure (where you had to demonstrate the complication was rare or cause by negligence) to treatment injury which includes all undesired effects, regardless of cause or frequency. Current cost $89 million
  3. A screed of 13 changes in 2007 as detailed below. Current cost at least $75 million. 
    • Cover for mental injury suffered arising from workplace traumatic events
    • Weekly compensation for seasonal and casual employees
    • Changes to cover provisions for work-related gradual process, disease or infection
    • Workers who are injured “between jobs” 
    • People receiving minimum weekly compensation
    • Loss of potential earnings compensation for young people
    • Abatement during return to work
    • Discretion to extend the three-year limit on vocational rehabilitation
    • Removal of upper age limit on vocational rehabilitation
    • Abatement of leave payouts for weekly compensation, when leave payment is made on termination
    • Extension of earner status to self-employed
    • Repeal of disentitlements for wilfully self-inflicted injury
    • Extending eligibility for lump sum entitlements under Work-related Gradual Process Disease or Infection
     

The astute will have noticed that these increases total only about $300 million. Assuming the population drivers already discussed are responsible for a third of the total $1.5 billion increase (i.e. about $500 million), that leaves a shortfall of $700 million. Incredibly, one can only come to the conclusion that ACC has indeed moved from being an accident insurance company to become a covert welfare agency. Only a cultural change such as this could explain the stupefyingly large increase in otherwise unexplained expenditure. It is therefore unsurprising that the blow-out in liabilities started well before the current economic difficulties. ACC was acting like a covert sickness benefit. Unfortunately, even if the ACC welfare culture changes overnight, we are stuck with the enormous liability it has generated.

Now you know why Ross Wilson’s ass is grass…

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  • The problem as I see it is, and always will be, that the majority of NZers don’t see/understand this. They still believe that the ‘gummint’ should take care of this. They don’t/wont understand that privatisation and capitalism are the tools that have enabled this country to have a ‘social conscious’ and without privatisation and capitalism there is NO money to fund a social conscious.

    The Labour Government spent like there was no tomorrow(and for them there isnt) but they forgot or ignored who it was that kept this country together. The capatisist. Profit is NOT a dirty word. It is what makes the world go around. Unfortunately I believe that with the state of the world today Maurice Strong is going to get his wish.

  • It might be true that the Standard is conveniently ignoring a few things, but so are you.

    The previous National government held costs by reducing entitlements. Some of Labour’s changes were restoring these. The increases have little, if anything, to do with competition.

    You are also ignoring the very high inflation rate in the health sector.

    The ACC scheme has always been a political football. The original proposal (so beloved by Nick Smith) was not implemented in full, and it would be more expensive.

    The uncomfortable fact for the right, is that elsewhere accident insurance is more expensive, as liability is unlimited, and they have to fund the legal industry. Of course insurance companies are keen to get into the NZ market. Liabilities are small and legal fees miniscule. Also ACC has to fund treatment for historical claims as well as those of the future. How can they compete?

  • Excellent piece MacDoc – I have linked to it here

    http://keepingstock.blogspot.com/2009/03/macdoctor-on-acc.html

  • Barry The previous National government held costs by reducing entitlements. Some of Labour’s changes were restoring these.

    Interesting allegation. Do you have any evidence of National doing this? I did think this might be a problem but could find no concrete example of National reducing benefits (they did, however make ACC staff police benefits more efficiently)

    You are also ignoring the very high inflation rate in the health sector

    Ah, yes. The famous myth of “medical inflation”.

    There is absolutely no evidence that increased costs in medicine are anything to do with inflation. Cost increases in medicine have always been driven by two things. Firstly, the increased trivialization of access (accessing health services for ever more inconsequential reasons), secondly, the “New and Improved” syndrome, where a medical procedure or drug with minor health benefits is touted (usually by the manufacturer of equipment or drugs) as the only ethical procedure or drug to use, because “outcomes are better”. Things such as staff wages and GP income (the main expenditures in medicine) barely keep up with the official inflation rate.

    The uncomfortable fact for the right, is that elsewhere accident insurance is more expensive

    This is nonsense.

    ACC expenditure = $3 billion
    Population of NZ = 4.3 million

    Cost/person = $700 for every man, woman and child in the country

    A family of four could purchase an unbelievably generous policy for considerably less than $2800 per annum. My medical insurance policy plus my lump-sum accident insurance costs my family less than that. $2800 for accident cover alone is outrageous.

  • Yep.

  • In addition to the changes in 2007, there were also changes in 2002 as a result of revising the ACC law in 2001 post the brief period of privatisation. This made a range of changes such as the maximum lump sum payment payable rising from $27,000 to $100,000 along with changes that were supposed tighten criteria, allowing those whose partners died in accidents lump sum payments and extension of compensation to some groups previously such as seasonal workers, passive smoking and those on unpaid maternity leave. They also allowed for changes that allowed compensation to be claimed for passive smoking. At the time the lump sum payment change was predicted to cost less than the old system in place which allowed for much smaller lump sums to many more claimants. One particular thing I remember is the drama about ‘sensitive claims’ ramping up massively after these changes and if I remember correctly this didn’t need to be proven at all by going through the courts or anything like that.

    It couldn’t be clearer on the graph that costs inexorably started rising after that point and this pattern cannot be attributed to the current economic crisis. You’d have to be looking at it incredibly superficially to not notice it’s a number of systemic problems due to the changes made over time that have contributed to the issues we are facing now.

    Thanks for pointing that out, Michelle. And you are right, you would have to be brain-dead (or an accountant) not to see the trend. ;-)

  • I know a guy who rides a brand new Harley. He bought it with the compensation he received from being sodomised while in foster care. He never actually got sodomised, but now he rides a Harley.

  • Excellent analysis MacDoctor. Thanks

  • National reduced entitlements: Well the elimination of lump sum payments is an obvious one. But they also fixed the compensation rates for various classes of injuries at levels below those that were commonly being applied before.

    Medical Inflation is not a myth: You might be right that some of the increase in costs is due to new treatments that are not more effective that the older cheaper ones, but that is not a fault of ACC. Some of the newer more expensive treatments are also highly effective.

    Not all ACC spending is on medical treatment. Some goes on allowances, some on accident prevention.

    You can’t compare ACC cover with health insurance.

    Your health insurance would be a lot more expensive if you had to cover for your personal accidents, your employees, liability for other peoples’ accidents, malpractice, lawyers’ fees etc. Your health insurance policy is reduced because the accident portion is covered by ACC.

    In the USA a doctor pays about US$100 000 per year for malpractice insurance. How does that compare to ACC?

  • barry: Elimination of lump sum payments merely shifted cost into the future, rather than reduced cost. Similarly, Labour reinstating them shifted the cost back into the present.

    Once again, there is no such thing as medical inflation. There are cost drivers involved in new procedures. But ACC has a perfect right to demand that these procedures be approved as more cost-effective than the other procedure available. Any normal insurance company would do this.

    By far and away the biggest cost driver for ACC is the fact that so many entitlements are now cost-free to the patient. Moral hazard would dictate that these services will be accessed to their maximum. Again, a normal insurance company would contain these costs by charging a small co-payment. A monopoly concern funded by the taxpayer, like ACC, would just throw up their hands and say “but you all want “free” services”.

    You can’t compare ACC cover with health insurance.

    I wasn’t. I was merely using it to illustrate the expensive nature of ACC. I am well aware that my policy is cheaper because ACC covers part of the accident costs. However, comparison with overseas policies should tell you that the accident part of the policy is actually quite cheap.

    My health policy would obviously not cover my employees (that would be a workplace policy) or public liability (that is built in to other policies). Nor does it cover legal fees and malpractice (I am not advocating the removal of no fault compensation, anyway).

    The USA malpractice premiums have nothing to do with the right to sue but everything to do with Tort law.

  • Your ACC expertise is being requested over here: http://www.mandm.org.nz/2009/03/one-year-on-and-another-setback.html

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