The New Zealand Health System
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1. Structure of the New Zealand Health System
Note: In an emergency, phone 111 for ambulance.
1.1 The System
New Zealand has a comprehensive system of publicly funded health services, complemented by private practitioners.
A 2007 Commonwealth Fund study comparing the quality of health services in six countries ranked New Zealand and Australia in 3rd place behind United Kingdom and Germany, and followed by Canada and the United States.
The public health system is funded through general taxation, and there is no specific health tax levied.
The Ministry of Health provides policy advice to government, administers health legislation, negotiates and monitors funding, and collects and analyses health-based information and statistics.
The 21 District Health Boards (DHBs) are elected agencies that allocate funding to the particular medical services needed in their particular geographical area. They purchase health and disability services from public and private providers of healthcare services, and monitor the performance of these providers. They also operate public health care and disability support services, including mental health care services. These services are centred around the operation of major public hospitals in the geographical area served by the particular operator.
Other healthcare services are provided by private practitioners and organisations. These practitioners may join a Primary Healthcare Organisation (PHO) and receive subsidies from their local DHB, enabling them to provide cheaper health care to patients.
Some services provided by private practitioners are fully or partially subsidised by government funding, and some must be paid for in full by the patient. The status of subsidies for certain services is discussed in Section 3, Specific Services. Note that the subsidies discussed will apply only to New Zealand citizens, Permanent Residents, and the other eligible migrant categories referred to in Section 2, Eligibility For Free and Subsidised Healthcare.
1.2 Accident Rehabilitation & Compensation Insurance (ACC)
In 1974, New Zealand introduced a system of comprehensive, no-fault insurance cover for accident-related injuries and disabilities, the ACC scheme.
The ACC scheme covers all New Zealand residents, New Zealand residents temporarily overseas, and overseas visitors while they are in New Zealand, regardless of nationality.
The introduction of ACC has removed the common law right to sue for damages, in return for providing a system of support for all injured people regardless of fault.
ACC is funded by all New Zealanders, through levies collected from employers, earners (employees and self-employed), and motor vehicle registrations. This is topped up by government allocations and fund investment earnings.
ACC covers all types of accidents, regardless of the situation and whether anyone was at fault. There are some restrictions on the cover provided for overseas visitors.
ACC contracts with service providers such as doctors, physiotherapists, hospitals, and occupational therapists to provide a range of subsidised services to injured people.
If you injure yourself through an accident, it is important that you indicate this to your doctor and fill out an ACC claim form.
1.3 Health & Disability Commissioner
The Health & Disability Commissioner promotes and protects the rights of health and disability services customers, and conducts investigations on behalf of individuals when complaints are made about public and private health practitioners.
Contact details for the Health & Disability Commissioner are provided in Section 6, Contacts and References.
2. Eligibility for Free and Subsidised Healthcare
2.1 Eligibility Criteria
The information in this section is a summary drawn from the 2003 Direction of the Minister of Health Relating to Eligibility for Publicly-Funded Health and Disability Services in New Zealand, which took effect from 30 October 2003. We recommend you confirm your own eligibility by referring to the Ministry of Health website, www.moh.govt.nz, click on “who is eligible for health services” to access the section, Eligibility for Health Services.
The main criteria for eligibility to publicly funded healthcare services is that you are either a New Zealand citizen or you are “ordinarily resident” in New Zealand.
To be “ordinarily resident”, you will need to meet one of the following criteria:
- Hold a residence permit. In addition, you must hold a current returning resident’s visa, or, immediately prior to seeking health services, have been in New Zealand for a period of at least two years.
- Hold a current work permit (and any renewals) that entitles you to remain in New Zealand continuously for two years or more. Any dependent children aged 19 or under are also eligible. (Note that the partners of eligible work permit holders are NOT eligible unless they hold a work permit in their own right.)
- Be a citizen of Australia, and be able to demonstrate you have been, or intend to, remain in this country for at least two years.
Certain other categories are also eligible. These include citizens of Niue, the Cook Islands and the Tokelaus (who are treated as New Zealand citizens in receiving publicly funded healthcare), refugees, and some other specific categories.
Citizens of Australia and the United Kingdom who are visiting New Zealand on a temporary basis (less than two years) are covered for certain forms of urgent medical care by specific reciprocal agreements with their countries.
People staying in New Zealand on visitor and study permits, and migrants who hold immigration permits to stay in New Zealand for less than two years, and do not qualify under any other criteria, should be aware that they will have to pay extra for most services. These migrants and visitors can be denied some services if they cannot demonstrate their ability to pay. Traveller’s medical insurance or private medical insurance is therefore advisable for these individuals, and this is discussed in Section 4 below.
Medical and travel insurance is compulsory for individuals holding student permits.
Family Planning Centres are free to all under 22.
2.2 Cardholder Subsidies
Low-income families and high-use patients qualify for higher subsidies, but must hold a Community Services Card or a High Use Card. Community Services Cards are applied for through Work and Income New Zealand (WINZ). High Use Cards are applied for through your doctor.
3. Specific Services
3.1 Hospital Services
The public hospital providers are responsible for delivering hospital and community-based health services to a certain area. These organisations operate the public hospitals.
Both in-patient and out-patient services at public hospitals are free to eligible individuals.
The standard of care at New Zealand’s public hospitals is generally of a high standard. Urgent and critical surgery is normally accommodated within the public system, but waiting lists can be lengthy for non-urgent and elective treatments.
Waiting lists can be avoided by utilising a private hospital. Private hospitals perform a range of surgery and medical treatments, but charge for these services. Note that the level of surgical and medical care in private hospitals in New Zealand is not regarded as superior to that provided in the public hospitals. The main reasons for choosing a private hospital are to have your treatment more quickly, and to enjoy more pleasant surroundings.
Hospitals are listed at the front of the Telecom Telephone Book.
3.2 Medical Practitioners
Primary care medical services in New Zealand are provided by General Practitioners (GPs).
GPs normally operate in private practices, often in partnership with other doctors in a Medical Centre. These practices are located in most suburban areas, and there will be a choice of practices in larger suburbs. Most GP practices have joined their local Primary Healthcare Organisation (PHO) so they can pass government subsidies on to their patients.
Most households will select a GP located close to their home for their regular family health care, although there are GPs operating in central city locations as well. Make sure your GP is part of a PHO, else you will pay more for services. You should register with the GP of your choice as soon as you have settled in an area, rather than waiting until you are ill and needing to see one urgently, as some practices have full patient lists. It can be difficult in some areas to get into a practice. You may have to attend a practice located further from your home. You can also ring your local PHO to find a doctor. Details of PHOs are listed on the Ministry of Health website, www.moh.govt.nz.
The cost of GP visits is subsidised by government for all age groups of eligible individuals who are enrolled at a participating medical practice (PHO), with higher subsidies applying to Community Services and High Use cardholders. The national average cost in 2007 of seeing a GP was $25, although the fees charged by individual practices vary. GP visits for children under six years will usually be free or at a small cost, and routine services for pregnant women are free.
House-calls (i.e. when the doctor visits you at home) are made only in exceptional circumstances, i.e. if you are physically incapable of visiting the surgery or after-hours clinic. A surcharge is levied on house-calls.
Specialist medical practitioners and surgeons are available through both the public and private systems. You will normally be referred to a specialist by your GP.
There may be a significant wait to see a specialist for certain medical conditions under the public system. Most specialists have both a private and a public practice, so there is effectively no difference in the quality of the care between the two systems – the only differences are the price and the waiting list.
GPs and specialists are listed at the front of the Telecom Telephone Book.
Other health practitioners such as dentists, physiotherapists, midwives, optometrists, podiatrists, chiropractors, etc, operate private practices, and can be sourced through the Telecom Yellow Pages telephone directory.
3.3 After-hours Clinics
The provision of after-hours medical care varies from region to region.
In the Wellington region this is provided by local GPs working together from designated after-hours clinics, often with an after-hours pharmacy (Urgent Pharmacy) nearby. After-hours clinics are open after normal working hours including weeknights, weekends and Public Holidays, however they may not be open overnight. After a certain time you may need to go to the hospital emergency department for treatment, but check with your GP for details of the service available in your area.
In Auckland, accident and medical clinics operate in many suburbs and are often just an extension of a clinic that operates as a normal GP practice during the day. Some will be open 24 hours, seven days a week.
3.4 Prescriptions
Doctors will prescribe prescription-only medicines, which are dispensed by pharmacies (chemists or drugstores). Pharmacies also sell non-prescription medicines, health products, beauty products and other cosmetic items.
Mainstream prescription medicines are fully subsidised for children under six years of age. Patients who are enrolled at a PHO practice pay $3 per item for most medicines prescribed by that practice, otherwise up to $15 per item. Community Services and High Use cardholders pay $3 per item.
There is a maximum of 20 chargeable prescriptions per family per year, then non-cardholder families pay $2 per item and prescriptions are free to cardholders. If you use the same pharmacy regularly for all members of the family, the pharmacist will keep records of the number of prescriptions issued, otherwise you will need to monitor this yourself. You can apply for a Prescription Subsidy Card when the limit has been reached.
Certain prescription medicines are not subsidised, and for some generic medicines only a particular brand name will be subsidised. In these cases you will pay the full cost of the medicine. If you do not qualify for subsidised health services (see section 2.1 above), you will have to pay the full price for medications.
Some restricted medicines may be available only from hospital pharmacies.
Pharmacies are only entitled to issue a month’s supply of most prescription medicines at a time. You pay the prescription charge up-front, and return to the same pharmacy to obtain any subsequent repeats.
3.5 Laboratory Tests and Radiology
Eligible individuals will generally not pay for most common laboratory tests ordered by their GP, but may have to pay for tests ordered by a specialist.
Requirements for X-rays and scans (such as mammograms, ultrasound, MRI and CT scans) are normally referred to a private radiology provider, and are charged to the patient. The exception to this is if the radiology service is requested by a public hospital physician, in which case the service would be performed by the public hospital, and therefore not charged to an eligible patient. There is a government breast screening programme which provides free mammography for women aged 45 to 70 years.
Laboratory and radiology test results are usually sent to the doctor who requested them. Your doctor will contact you if any action is required as a result of a test.
3.6 Maternity Care
There is little or no cost for maternity services to women who are eligible for publicly-funded healthcare. In general this covers pregnancy, childbirth and post-natal care services provided by GPs, midwives, public hospitals and the Royal New Zealand Plunket Society. There will be charges for seeing private obstetric specialists.
Pregnant women elect a principal maternity-care provider to co-ordinate their healthcare needs during their pregnancy. This is usually their GP or a mid-wife. However, most GPs no longer act as principal maternity-care providers, and this role is commonly fulfilled by midwives. Some women may require care from a specialist obstetrician, but will need to pay to see private specialists.
The Royal New Zealand Plunket Society provides support services for mothers and newborn babies. Plunket clinics check the child’s progress, and to offer advice on any problems. There is no charge for this service, but donations are welcomed. Plunket also operates a free helpline to answer queries on children’s medical problems – 0800 933 922.
The majority of women choose to have their babies in hospital, although many midwives and GPs will provide support for home-births.
3.7 Dental Treatment
Routine dental treatment is free for children up to the age of 16, and also for those adolescents over 16 who are still attending school. These services are provided either by school dental clinics or by dentists as appropriate. All other dental care is generally provided by private practitioners and is paid for by the patient. Some dental treatment is provided free of charge through the public hospital system.
3.8 Optical Care Services
Except for those optical services provided by public hospitals, all optical care is provided by private practitioners, and is paid for by the patient.
3.9 Ambulance Services
Ambulance services are provided by independent operators such as the Order of St John, in most parts of the country, and Wellington Free Ambulance in Wellington.
Services are funded by the ACC if the service is in response to an accident, otherwise a charge to the patient applies (around $70-$80). In Wellington, services are generally provided by Wellington Free Ambulance, and are free to the patient.
In an emergency, dial 111 for an ambulance. If you require an ambulance for non-urgent service, call the provider in your local area.
4. Medical Insurance
Many New Zealanders have taken out private medical insurance to cover some of the costs of private medical care, and to provide improved access to elective and non-urgent surgery. Some employers offer medical insurance as part of their employee benefits packages.
There are many companies offering medical insurance with a myriad of schemes and premiums, so it is important to shop around to find a policy that best suits your circumstances. Some companies offer “hospital-only” policies, which only provide cover for major surgery. The major insurers are Southern Cross, Tower Health & Life, Unimed and Sovereign. Check www.ezimed.co.nz for comparative information on certain medical insurers.
Most insurers will not cover pre-existing conditions for new policies. You should take this into account when weighing up the cost of premiums against the suitability of the policy and the cover you require.
As we have stated previously, the real benefit of medical insurance in New Zealand is to assist you financially in accelerating treatment for which you would have to wait under the public system. There is no recognised difference in the quality of medical care provided by private and public hospitals, (except that the public hospitals typically have more extensive back-up and critical care facilities), and the same specialists and surgeons practise in both environments.
If you are eligible for publicly funded health services (see Section 2 above), you will need to weigh up the comparative costs of paying medical insurance premiums, against the likelihood and costs of needing specialist attention, an operation or an ancillary service that cannot be sourced speedily in the public system. Note that you
will generally receive prompt, high-standard care within the public system for any emergency or life-threatening condition.
If you are not eligible for publicly funded health services, we strongly recommend that you have medical insurance, but note that the premiums for this may be high. If you are going to be in New Zealand for less than a year you may have difficulty in finding an insurer to provide short-term cover, although there are some insurers providing policies for students. In this case, we recommend you obtain medical cover through a travel insurance policy from your home country prior to arriving in New Zealand.
Medical and travel insurance is compulsory for individuals holding student permits.
Some indicative costs (in NZ$) for certain privately provided operations and ancillary services are:
Dentist examination,
scale & polish $50-$100
Specialist visit $80-$200
Mammogram $90-$150
CT Scan (Chest) $500+
MRI Scan $800
Extract wisdom teeth $1600-2000
Dental implant $4000-$6000
Varicose vein $3500
Hernia $4500
Angiogram $4500
Angioplasty $13000
Gall Bladder $6500
Cataract Removal $3000
Tonsils and adenoids $4000
Hip replacement $15500
Knee Replacement $15500
Heart Surgery $15,000-$30,000
Laparoscopic Hysterectomy $8500
5. Health Care Services in Wellington
5.1 Emergency Services
In an emergency, dial 111 to call an ambulance.
Ambulance services in the Wellington region are provided by the Wellington Free Ambulance. There is no charge to patients for this service.
The LifeFlight Trust, with its major sponsor Westpac, operates an emergency helicopter service.
The major hospitals in Wellington (Riddiford Street, Newtown) and Lower Hutt (High St) operate 24 hour, seven day Accident and Emergency departments. If your condition is not serious, you should attend your local GP or after-hours clinic rather than approach the hospital directly.
5.2 Hospitals
The Wellington area is served by two public hospital operators – Capital & Coast District Health Board (for Wellington, Porirua & Kapiti Coast residents) and Hutt Valley District Health Board (for Hutt City & Upper Hutt residents).
These providers operate the public hospitals. There are three major public hospitals in the Wellington area for general medical and clinical services:
Capital & Coast District Health BoardWellington Hospital Riddiford St, Newtown, 385 5999
Kenepuru Hospital Rahia Street, Porirua, 237 0179 Hutt Valley District Health Board
Hutt Hospital High Street, Lower Hutt, 566 6999
Private hospitals in the Wellington area that perform surgery and offer specialist services and medical treatments include Bowen Hospital (Chartwell), Boulcott Clinic (Lower Hutt), Southern Cross Hospital (Newtown), and Wakefield Hospital (Newtown).
5.3 After-hours Clinics
After-hours clinics in the Wellington area are located at:
Wellington: 17 Adelaide Rd, Newtown, (384 4944)Open 8am-11pm 7 days Porirua: Kenepuru Accident & Medical (Kenepuru Hospital), Raiha St, Porirua (918 2300)
Open 8am-11pm 7 days Lower Hutt: 729 High St (567 5345)
Open 5.30pm-8am Mon-Fri, 24 hours Sat-Sun Upper Hutt: 12-14 Royal St (920 1800)
Open 8.30am-7.45pm Mon-Fri, 9am-5.45pm Sat-Sun
Opening hours may change. We suggest you ring the clinic to check it is open before attending. If the clinic is closed you can go to A&E at Wellington Hospital or Hutt Hospital. In an emergency dial 111 for an ambulance.
“Urgent” pharmacies, which are open after normal working hours are located beside the after-hours clinics in Wellington, Porirua and Lower Hutt, and at 35 Queen St, Upper Hutt. For opening times and contact details look under Urgent Pharmacies in the phone book.
5.4 Laboratory Tests
If your doctor refers you for blood or other laboratory tests, these can be carried out by:
Aotea Pathology 89 Courtenay Place (381 5900)44-50 The Terrace (381 5900 ext 845)
40 Riddiford St, Newtown (381 5900 ext 835)
58 Miramar Ave, Miramar (388 5877)
17 Raroa Rd, Lower Hutt (586 8567)
Upper Hutt Health Centre, off Queen St carpark
24 Moorefield Rd, Johnsonville (939 4633)
6 Hartham Place, Porirua (237 8600)
Check www.apath.co.nz for further details and opening hours as these vary.
Some testing is also conducted by mobile testers at doctors’ surgeries. Check with your medical centre for times.
5.5 Radiology
X-rays and other radiology services are performed by:
Pacific Radiology Tel: 978 5500Wakefield Hospital, Rintoul St, Newtown
Old Public Trust Building, 131-135 Lambton Quay, Wellington
12-14 Moorefield Road, Johnsonville
668 High St, Lower Hutt
The Health Centre, Off Queen St Carpark, Upper Hutt Kelvin Radiology Advantage House, 50 The Terrace, Wellington (472 3680) Bowen Radiology Churchill Drive, Crofton Downs (479 7043) Porirua Radiology Hartham Place, Porirua (237 8362)
6. Health Care Services in Auckland
6.1 Emergency Services
In an emergency, dial 111 to call an ambulance.
Ambulance services in the Auckland region are provided by the Order of St John. There is a charge to patients for non-accident related services.
Most major public hospitals in Auckland operate 24 hour, seven day Accident and Emergency departments, but check with your nearest hospital to ensure this is the case. If your condition is not serious, you should attend your local GP or after-hours clinic rather than approaching the hospital directly.
6.2 Hospitals
The Auckland area is served by three public hospital operators – Auckland District Health Board servicing the central Auckland area, Counties Manukau District Health Board servicing south and east Auckland, and Waitemata District Health Board servicing the north and west of Auckland.
These providers operate the major public hospitals in the Auckland area for general medical and clinical services.
Auckland District Health BoardAuckland Hospital Park Road, Grafton, 367 0000 (Accident & Emergency)
Starship Children’s Hospital Park Road, Grafton, 367 0000
Green Lane Hospital Green Lane West, Epsom, 367 0000
National Women’s Hospital Claude Road, Epsom, 367 0000 Counties Manukau District Health Board
Middlemore Hospital Hospital Road, Otahuhu, 276 0000 Waitemata District Health Board
North Shore Hospital Shakespeare Rd, Takapuna, 486 8900
Waitakere Hospital Lincoln Road, Henderson, 839 0000
Private hospitals in the Auckland area that perform surgery and offer specialist services and medical treatments include Adventist Hospital (St Heliers), Ascot Hospital (Remuera), Mercy Hospital (Epsom), and Southern Cross Hospitals (Epsom and Glenfield).
6.3 After-hours Clinics
There are many after-hours and accident clinics in the Auckland area, some of which are open 24 hours, 7 days. Check under Registered Medical Practitioners & Medical Centres at the front of the Auckland Telephone Book for your nearest clinic. Many of these clinics also operate an adjacent pharmacy.
Additional after-hours pharmacies are listed at the front of the Auckland Telephone Book under Hospitals and Other Health Service Providers (under Pharmacies-Extended Hours and Urgent Pharmacies).
6.4 Laboratory Tests
There are multiple providers of medical laboratory services in the Auckland area. Your doctor will be able to refer you to your most convenient provider.
6.5 Radiology
There are multiple providers of X-rays and other radiology services in the Auckalnd area. Your doctor will be able to refer you to your most convenient provider.
7. Contacts & References
In an emergency, dial 111 to call an ambulance.
7.1 Government Agencies
Ministry of Health
Head Office, PO Box 5013, Wellington 496 2000
www.moh.govt.nz
Accident Rehabilitation & Compensation Corporation (ACC) 0800 101 996
Health & Disability Commissioner 0800 11 22 33
7.2 Help Lines
Emergency 111 (ambulance, fire, police)
Emergency facsimile for the deaf 0800 16 16 10
Health Line 0800 611 116 (general health advice)
Plunket Line 0800 933 922 (advice on health issues of young children)
Alcohol Helpline 0800 787 797
Alcoholics Anonymous 0800 229 6757
Breastscreen Aotearoa 0800 270 200 (free mammograms)
National Cervical Screening 0800 729 729
Quit Line 0800 778 778 (stop smoking)
ENABLE 0800 171 981 (disability information & referral)
Narcotics Anonymous 0800 628 632
Gambling Crisis Hotline 0800 654 655
Youthline 0800 376 633
Citizens Advice Bureau 0800 367 222
Family Planning Association Wellington 04 499 1992
Gay Switchboard Wellington 04 473 7878
Lesbian Helpline Wellington 04 499 5567
Gay & Lesbian Line Auckland 09 303 3584
The Pride Centre Auckland 09 302 0590 (gay, lesbian support centre)
NZ AIDS Foundation Wellington 04 381 6640 (Awhina Centre)
Auckland 09 309 5560 (Burnett Centre)
AIDS Hotline 0800 802 437
Community Alcohol & Drug Services Auckland 09 623 2323
The Women’s Centre Auckland 09 376 3227
8. Glossary
ACC: Accident Rehabilitation and Compensation Corporation
Community Services Card: Card for people on low-incomes, entitling them to greater public health benefits.
DHB: District Health Board
GP: General Practitioner, i.e a primary care provider, family doctor.
High Use Card: Card for people who visit the doctor often with chronic illness, entitling them to greater public health benefits.
Pharmacy: Chemist or drugstore. Dispenses prescription medicines, and sells other merchandise.
PHO: Primary Health Organisation
Plunket: Royal New Zealand Plunket Society, a voluntary welfare organisation, largely government-funded that provides support for mothers and infants.