Hmm, this is interesting. I'm thinking maybe it would be worth them looking more at the job descriptions and what the risks are in that role. Rather than it always being just because you’re in the higher tax bracket you have to pay more. If it is a CEO of a company and they earn 100k+ a year but have a pretty low risk job then why should they be paying more than that of a factory worker who is doing a shit load of lifting? If there is an increase of ACC claims in the workplace then there has to be evidence also of where these are happening and what sector they are coming from... Maybe that’s where the focus needs to be rather than how much people earn...

Hmmmm... I thought premiums were based on risk profile by occupation... I vaguely remember when I set up my company that it took me absolutely ages to determine which "category" I was in on the ACC website. Different categories have different premiums - presumably risk-based. Forestry workers, for example, pay higher premiums than sedentary workers... but please don't quote me on this because I haven't gone back to check on this - just relying on my somewhat (aged) memory... :-)

Which can be a whole new topic unto itself: maybe forestry workers are "fitter" than regular-sit-down workers and therefore they could get some insurance premium relief because of that...? It could be argued that people's premiums should be based on their fitness/health AND job profile...?

Imagine if the government really put its energy into creating a healthier population rather than continuing to be the ambulance at the bottom of the cliff... Now wouldn't that be something to sing and dance about?

Great points Julia! But how would it work if I were a full time clerical worker but cycled to work, ran round the park most lunch times and did yoga on the weekends? Based on being a clerical worker, I would be paying heavy premiums, based on my recreational activity, much more affordable ones. Who would check that my recreational activity was accurate and consistent?

Perhaps if we could figure that bit out, it could be a great incentive to help get more people more active and thereby working on removing the ambulance from the bottom of the cliff?!

So you tore a calf muscle playing a voluntary game of netball and the taxpayer paid for your phyio to provide you postural analysis, massage and accupunture? Damn nice of the poor old taxpayer! But really is that appropriate treatment or taking the p*ss? What more was really necessary than an assessment of how severe the injury was and advice on the best application of the commonly known 'RICE' principle? And then additional therapies to speed recovery being paid for completely by the end user, after all you play sport voluntarilly. From memory ACC origonally forecast that its subsidy for physio treatments would cost approximately $30 million per annum. Last year however the cost exceeded $140million per annum for the subsidy paid to physios. So to me something certainly seems in dire need of fixing. I heard recently that the government was looking to cut over 700 school teacher positions to save expenditure. I wonder how we'd feel if these positions were cut but we could still get free or very cheep massage and accupunture when we strain muscles on the court or footy paddock? And how do the masseauses that specialise in deep tissue therapy or the accupuncture guru's feel when physio's not necessarilly as highly trained as they, are subsidised for the provision of such services because they do so under the banner of 'physiotherapy'? One of the previous comments related to asking how good it would be if the government found ways to encourage more kiwis to be physically active which made me wonder - what would happen if the government suddenly subsidised Personal Training so that it could be delivered 'free' to the end user? Sadly I think the result would be disasterous, because the end user would'nt have to pay they wouldnt expect as much from their service provider, and the service provider wouldnt be as accountable for providing the outcomes clients seek in the most appropriate, time efficient manner. Personally I think the ACC review (of the subsidy it provides to pysiotherapy at least) is fantastic, it means the consumer will expect more and the provider must ensure they deliver only and exactly what the customer needs in order to meet their expectations. And if $$ are saved in this area then they can go on the provision of care to those who really need it - those incapacitated by workplace accidents, age or illness.

I've lived in NZ and USA. One system is very capitalist and the other was, at least during my upbringing, a cradle-to-grave welfare system. I've come to the point where I think we desperately need capitalists to push productivity so we can all enjoy prosperity but we need a very strong social conscience and willingness to care beyond our immediate community with taxes and an efficient government. I would describe myself as moderately neighbourly, entrepeneurial, and a pragmatist when it comes to realising I should pay a good whack of tax to live in a country like this and make sure others have what they need. That said, as a pragmatist I'm most interested in seeing my tax dollars go to the most needy, those who have fallen and have the gumption to climb again, and those who simply for one reason or another are not well equipped for our economic model. So where does that leave ACC in my view. ACC is a monster that is inefficient, not targeted enough and generally too generous. I believe a base of care should be provided to everyone, but that base should be just enough to make a difference and not a risk mitigation opportunity for the highly active or inactive or just plain silly - that is those who are most at risk should, where they are making those decisions willingly (or voluntarily as Dan comments), meet the costs of that risk taking. In business and life you have generally three categories of risk - transferable, avoidable, and self. Transferable is a risk that is significant and should be transfered through insurance - an example might be life or trauma insurance for a key person in a business or household in terms of income. Avoidable is risk that once understood can be worked around or managed in some way - an example might be having succession plans in a business or not putting an ejector seat in a helicopter. A 'self' risk is a risk that you can manage by being a more careful you. It's a risk that exists for all of us but is best managed by exercising care in general. So, ACC in my view is providing a transferable risk solution where avoidance and/or self risk is actually evident. It's a fact that those who play rugby get injured often. The fact that ACC picks up this tab is encouraging less care than is necessary to avoid or take more care when risk is evident. Yes, they have a premium in place, but in my mind it's not achieving desirable outcomes - ie less injury through more individual responsibility, more avoidance. Would I rather pay for Big Dan to smash Fat Fred on the rugby field? Or, for someone in my family to get a cancer drug, or for better aged care, or for more teachers or for better housing. I would much rather have those taking risks meeting the costs most of the time and have my taxes being used for core welfare - the research showing that is; houses that are dry, safe and sound; education that is comprehensive, modern, and accessible; health care that is responsive, timely and effective. The other aspect of the system is the unethical use of descriptors on the injury forms. Some time ago ACC started to challenge more 'sports' injuries. As a result those earning a living from ACC subsidised activities 'cued' patients to fill out forms with 'home-based' injuries being the cause so payment was guaranteed. Naturally a swelling of claims with 'workplace' causes and 'home' causes has occured - the sign that those within the system are now manipulating the system to maintain volume - the self preservation of the budget blow out seems assured for some time yet. A 'fair' system is not 'equitable'. That is equal is not fair. Ask my kids! ACC levies are already linked to income as by default those who earn more pay more ACC levies - it's about 2-3% of earnings. So, we already have an 'index' related scheme as you have described it. What we don't have is an efficient and effective spend with the proceeds that are available from the tax payers purse because of a mixture of our keenness as individuals to transfer risk rather than manage it and our acceptance that it's not our money that ACC providers are fleecing when we have our 'home based calf/back/knee' injury. In NZ we are slowly moving down the OECD, our health system is very overloaded, we have an aging population, we have a balance of account deficit which is swollen year after year and we continue to show love for frivolous uses of money and finance. I don't want to see the USA system, it's broken too, but I do want to see my taxes being used for things other than caring for the commonly seen ACC stalwarts whose histories are longer than David Letterman's recent apology notes to staff and family.