New Zealand is an island country located in the southwestern Pacific Ocean with a population of roughly 4.86 million people. According to the data provided by the Organisation for Economic Co-operation and Development, New Zealand ranks above average in income, wealth, and health care (Cumming, 2017). The latter is the central focus of the current paper: it delves into the history of the healthcare system in the country and describes its current state in detail. For many decades after the first contact of colonizers with the indigenous Maori nation, New Zealand did not have any centralized healthcare system. Locals preferred traditional and spiritual healing practices, while European settlers had to resort to alternative medicine due to the high price of professional medical services. The first serious milestone for the NZ healthcare system was passed in 1872 the Public Health Act 1872 introduced health boards (“Chronology of the New Zealand Health System,” 2017). While health boards were funded by local ratepayers and received subsidies from the government, they were still far from being sustainable. Any shortfall was covered by private charities, and medical care was not equally delivered to all in need.
It was not until 1938 that the New Zealand government introduced the Social Security Act that attempted to provide free healthcare to everyone. While the motivation for the act was justified, in practice, the new legislation disadvantaged the doctors, which made them charge those who could afford to pay for services. In the 1980s and early 1990s, the Labor and National government made sweeping changes that encouraged are health boards to work as market forces (“Chronology of the New Zealand Health System,” 2017). From then on, the government has tried many policies, some of which were deemed controversial and failed while others stayed to this day. Today, the New Zealand healthcare is a public-private system for delivering healthcare. While it is evaluated highly by institutions such as the OECD, there are still some systemic inequities of access and outcome (Cumming, 2017).
Generally, healthcare services are available to New Zealand residents and some work visa holders: these categories of people can benefit from a public health system that is either free or low cost. This is made possible by heavy government subsidies that are driven by the idea that “everyone [should get] ‘a fair go’ in life (“Healthcare,” 2020).” New Zealand residents have the right to take out medical insurance for private healthcare; yet, as the government’s official website suggests, this is not a popular option (“Healthcare,” 2020). Non-residents can pay for healthcare services out-of-pocket, but they are still obliged to purchase medical insurance from their home country. The Ministry of Health (2011a) provides a comprehensive list of all categories of people who are eligible for healthcare services. The said list includes but is not limited to:
- country citizens, including those residing on the Cook Islands, Niue, or Tokelau;
- holders of New Zealand resident class visas;
- holders of work visas enabling them to stay in New Zealand for two years or more;
- people aged 17 or younger in the custody of an eligible parent or legal guardian;
- refugees and protected people, and others.
The New Zealand government strongly recommends acquiring comprehensive medical insurance that would cover the majority of healthcare and disability services. According to the official website, in New Zealand, medical insurance: (1) subsidizes primary medical services such as doctor’s visits; (2) subsidizes prescribed medication; (3) provides free public hospital services; and (4) covers services for disabled residents (“Paying for healthcare services,” 2020). In particular, the Ministry of Health (2011a) states that visiting a local doctor or a general practitioner is free. So is receiving acute or emergency care: inpatient and outpatient treatment, including X-rays and laboratory tests, are free of charge. The Accident Compensation Corporation (ACC), a state agency, covers no-fault personal injury for all New Zealand residents and visitors. Dental services are mainly available to eligible children under 18 years old; the number of adult services funded by the government is limited. Lastly, the majority of maternity care services are free for women.
The official websites do not contain any mentions of income as a decisive factor in collecting money. A person’s health status makes them eligible for receiving a referral to other specialists. The money is administered both by the government and private insurers. As of now, the Ministry of Health is allocating around 75% of public funds that it is managing through Vote Health. Funds are distributed to the district health boards that use them to plan, buy, and provide health services within their designated areas (Ministry of Health, 2016).
As mentioned before, the New Zealand healthcare is a public-private system for delivering healthcare. There are private insurance companies that offer additional services that are not covered fully by public healthcare such as sterilization, voluntary treatment overseas, and home nursing. To be eligible to take out private insurance, a person needs to be eligible for publicly funded healthcare. On the one hand, cost-sharing is a valid and conscious personal choice made by the consumer. On the other hand, in some cases, cost-sharing is a product of inequalities that the New Zealand government is working hard on eliminating. The Ministry of Health (2011b) points out that Maori and Pacific people, in general, are doing worse than other ethnic groups.
As suggested by the General Practice New Zealand (2019), medical force recruitment in New Zealand is becoming increasingly difficult. Yet, there are positive findings from the 2018 Workforce survey: they suggest that the size of the medical workforce has been steadily increasing since 2013 (The Medical Council of New Zealand, 2018). As of now, there are 16,292 doctors and nurses, or 333 specialists per 100,000 New Zealand residents (The Medical Council of New Zealand, 2018). There is no available information about the ratio between primary care doctors and specialists. The only related figure published in recent years is the 1:1 ratio between doctors and nurses.
In New Zealand, doctors work both solo and in multidisciplinary teams that approach a patient’s problem from various angles, thus, providing a balanced view and boosting the efficiency of the intervention. The NZ healthcare system is characterized by the presence of “gate-keepers.” As reported by the Ministry of Health (2019), there is an established process for how a person should be treated. Typically, a person who requires medical treatment sees their primary care provider first who is often a general practitioner (GP). A primary care provider conducts a primary assessment and outlines the best options that may include a referral to a specialist. The referral is then looked at by a prioritizing clinician, who decides whether it is justified based on the person’s level of need. To sum up, a clinician whether to accept, decline or transfer the referral or maybe suggest more tests. If a referral is accepted, then a person receives a First Specialist Assessment within four months.
As for other features of healthcare delivery in New Zealand, at present, the country increasingly relies on medical data for improving services. McBeth (2019) reports that in 2019, the Ministry of Health appealed to Cabinet to receive approval to develop a national Health Information Platform (nHIP). The Ministry decided to move beyond the idea of building a single Electronic Health Record for the entire country. Now it is trying to create an nHIP that would enable real-time clinical decision support and help patients self-manage their health.
Like any other system, New Zealand’s health care has its strengths and weaknesses. As of now, despite being only partly socialized, the system is reflective of the country’s commitment to turning medical care into a social right. The government is well aware of the persistent shortcomings such as unequal access by Maori and Pacific people and deems them remediable and changeable given a consistent and guided effort. Health care is offered to visitors under special conditions and overseas refugees. A key strength that will yield more benefits, in the long run, is the use of data in care delivery that enables self-management and prompt response. On the contrary, the New Zealand healthcare system is still bureaucratized, which is shown through the example of what a person has to go through to receive a First Specialist Assessment.
Chronology of the New Zealand health system 1840 to 2017. Web.
Cumming, J. (2017). New Zealand’s health service performs well, but inequities remain high. The Conversation. Web.
The General Practice New Zealand. (2019). Workforce and resources for future general practice. Web.
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McBeth, R. (2019). New Zealand’s National Health Information Platform replaces EHR. Healthcare IT News. Web.
The Medical Council of New Zealand. (2018). Workforce survey. Web.
The Ministry of Health. (2016). Funding. Web.
The Ministry of Health. (2019). National Patient Flow: Prioritisation outcome of referrals for first specialist assessment tables (developmental). Web.
The Ministry of Health. (2011a). Publicly funded health and disability services. Web.
The Ministry of Health. (2011b). Reducing inequalities in health. Web.
Paying for healthcare services. (2020). Web.