New Zealand is a small South Pacific nation island nation which has developed a strong economy, high standard of living and a commitment to publicly funded healthcare for all citizens and permanent residents. Healthcare is funded by taxation and until July 2022 was administered regionally via twenty district health boards which provided primary medical services, hospital in patient and out patient care, psychiatric care, public health, long term care and dental care.

In July 2022, the district health boards were replaced by a single healthcare organisation Te Whatu Ora Health New Zealand which has responsibility for planning, purchasing, and providing health services nationally with local delivery via the hospitals and clinics of the former district health boards. The national government sets the overall strategy and goals for healthcare provision and an annual budget and benefit package for the regions.

Just over 30% of New Zealand's population has private medical insurance to help pay for services which are not covered by the government, copayments and rapid access to private medical consultations and elective surgical procedures.

The Development of New Zealand's Healthcare System

New Zealand's culture is a blend of two distinct cultures, that of the indigenous Maori population which forms almost 20% of the total population and that of the European settlers. The former is holistic and community focused, the latter more individualistic. But over time a consensus developed that government has a fundamental role in providing essentials medical care for the population.

The passage of the Social Security Act in 1938 following the extreme hardships of the great depression, established New Zealand as a welfare state. This act is important in the history of politics and social welfare. It established the first social security system in the world and paved the way for the eventual achievement of the government's goal of universal health coverage funded by taxation.

Interestingly, the greatest opposition to state funded healthcare came from the New Zealand Branch of the British Medical Association (BMA) which objected to the implementation of free general practitioner consultations on the grounds that the unique and confidential doctor patient relationship would be compromised by the imposition of the state.

Initially doctors refused to accept a state fee for their services arguing that the doctor–patient relationship was dependent on direct payments from the patient. It was only in 1941 that a compromise was reached between physicians and government whereby doctors charged patients directly and patients could then claim a social security refund.

Since that time, universal tax payer funded healthcare has continued in New Zealand and currently all citizens and permanent residents have access to medical and dental care, free at the point of delivery. No citizen or permanent resident can be denied treatment in public hospitals.  In practice, however, the availability and quality of medical services  varies by location and service. The Maori population have persistently poorer healthcare outcomes, more limited access to medical services and shorter life expectancy than the rest of the population.

The Role of Government in Healthcare

The national government of New Zealand dominates all aspects of healthcare as its primary funder and supplier. It sets healthcare policy, strategy, goals and regulations and monitors compliance.

Once the government has defined the national health care policy agenda and service requirements, it then determines an annual overall budget and benefit package, based largely on political priorities and health needs.

Government-funded and government-appointed entities dominate healthcare governance structures. Some operate at arm’s length from the central government, such as the Health and Disability Commissioner, which champions consumers’ rights in the health sector. Others are “crown agents,” funded by government, with their own boards, and are required to follow government policy.

Key national entities are:

The Ministry of Health: this has overall responsibility for the health and disability system, acts as the Minister of Health’s principal adviser on health policy, and maintains a role as funder, monitor, purchaser, and regulator of health and disability services.

The Technology and Digital Services business unit: this unit within the Ministry of Health, is responsible for implementing the government’s Digital Health Strategy and other e-health initiatives.

The Capital Investment Committee: this is a Ministry of Health subcommittee which advises on matters relating to capital investment in the public health sector in accordance with the government’s service plans.

Health Workforce New Zealand: this organisation leads and supports health and disability workforce training and development.

NZ Health Partnerships: this organisation is owned and supported by Te Whatu Ora Health New Zealand and is responsible for helping the health service pursue bulk procurement of medical equipment, devices, and services including banking.

The Pharmaceutical Management Agency of New Zealand: this agency assesses the effectiveness of drugs, distributes prescribing guidelines, and determines the inclusion of drugs on the national formulary.

The Health Quality and Safety Commission: this commission is working towards the goals of improved quality, safety, and experience of healthcare; improved health and equity for all populations; and better value for public health system resources.

The Health Promotion Agency: this agency develops and enables health-promoting policy, initiatives, and environments.

The Health Research Council: this council invests in a broad range of research on issues important to New Zealand.

According to the World Bank, total health spending in New Zealand was 9.74 % of GDP in 2019 (the latest date available); an exponential increase since 2000 when it was just 7.47%. Public spending accounts for about 77% of total spending.

All citizens and permanent residents have access to a broad range of medical services which are largely publicly financed through allocations from pooled general taxes, collected at the national level. One exception is treatments related to accidents, which are covered by a no-fault accident compensation scheme.

Nonresidents, including tourists and undocumented immigrants, are charged the full cost of services by public health care providers.

Public Health Services Provided

Te Whatu Ora Health New Zealand provides the following services:

• preventive care including immunisations and cancer screening
• inpatient and outpatient hospital services
• primary care via private providers, except for certain services, such as optometry, adult dental services, orthodontics, and physiotherapy
• maternity services
• physical therapy
• durable medical equipment
• inpatient and outpatient prescription drugs included on the national formulary
• mental health care
• dental care for schoolchildren
• long-term care
• home help
• hospice care
• disability support services.

Cost-Sharing for GP Services and Prescribed Drugs

Most visits to a General Practitioner (GP) attract a fee or co-payments for the service of the physician and many of the  nursing services provided in GP clinics. The average adult copayment for a GP consultation varies significantly, from NZD 15 to NZD 50.

In general, the government does not set limits on GP copayments, although the government has capped GP copayments at NZD 17.50 for one-third of New Zealanders residing in low-income areas.

For drugs prescribed by GPs and private specialists, copayments of NZD 5.00 are required for the first 20 prescriptions per family per year, after which there are no copayments.

Primary care is mostly free for children ages 13 and under and is subsidized for the 98 percent of the population enrolled in networks of primary health organizations.

Patients who have had more than 12 GP visits in a year can apply for a high-use health card, which reduces the amount they owe in copayments. Low-income people can also lower their copayments by seeking a community services card.

Private Health Insurance

Private health insurance is offered by a variety of organisations, both profit and non profit making, for coverage of private elective surgery, faster access to non urgent treatment, private specialist consultations and coverage of cost sharing fees.

It accounts for about 5 percent of total health expenditures and can ensure faster access to nonurgent treatment. About one-third of the population has some form of private insurance, and it is purchased predominantly by individuals.

Physician Services and Remuneration

All physicians practising in New Zealand must be registered with the Medical Council of New Zealand, the sole national medical regulatory authority for physicians.

The Medical Council of New Zealand (MCNZ) is responsible for maintaining a register of physicians, issuing annual licences to practice, upholding standards of medical practice and the administration of the NZREX exams for international medical graduates who wish to practise in New Zealand.

There is no limit to the number of registered physicians. However, there are only two medical schools in New Zealand; The University of Auckland in the North Island and the University of Otago in Dunedin in the South Island. Both universities are public and funded by the government which determines the number of places available for study.

New Zealand has a shortage of junior doctors working at the house officer and registrar level (resident medical officers - RMOs) and attracts recently qualified physicians from Australia, UK, Ireland and other European countries which are considered to have comparable healthcare systems to New Zealand. (For details of how to register with the MCNZ, please read our article on medical professional registration in New Zealand.). There are vacancies across New Zealand for junior doctors in accredited training roles and non accredited service positions in most specialties.

New Zealand's postgraduate medical training in supervised by the Australian and New Zealand medical specialist colleges which determine the qualifications for entry to specialist training, the modules of basic and advanced training and the standards required to complete the fellowship examinations.

The colleges also restrict the number of accredited training positions available. This leaves New Zealand with a chronic shortage of specialists in several fields, particularly psychiatry, anaesthesia, radiology, emergency medicine, obstetrics and gynaecology and internal medicine.

New Zealand is a popular choice of work location for international medical graduates at the levels of junior doctor, specialist and general practitioner. Salaries are compatible to and sometimes better than the equivalent offerings from the UK's National Health Service (NHS) whilst the work conditions are superior with generally lighter workloads leaving more time for study and recreation. For Canadian and American residents, New Zealand offers considerably higher salaries.

New Zealand's postgraduate training and fellowships are excellent, internationally highly rated and accepted by most leading medical regulatory authorities.

Primary Medical Care

General Practitioners are responsible for the provision of primary care in the community and act as the gate keepers to specialist services. Their role includes preventative medicine and the management of chronic conditions.

Patient registration with a general practice is not mandatory in New Zealand, but GPs and primary health organizations must have a formally registered patient list to be eligible for government subsidies. Patients enroll with a GP of their choice; in smaller communities, choice is often limited.

An average of 3.48 GPs work together in each practice, assisted by practice nurses. Nurses are paid a salary by GPs and have a significant role in the management of long-term conditions like diabetes, incentivised by government funding for chronic care management.

GPs are usually independent and self-employed. Most belong to one of about 30 primary health organizations (PHOs), which are networks of providers.

About half of a GP’s income comes from capitated, government-determined national subsidies, paid through the primary health organizations. The capitation rate is periodically adjusted in negotiations with GPs and primary health organizations.

Patient copayments, set by individual GPs, and payments from the Accident Compensation Corporation account for a GP’s remaining compensation. In general, copayments are not regulated by any fee schedule; however, the government caps copayments for New Zealanders residing in low-income areas. A higher annual per-patient capitation rate is paid to GPs for these low-income patients.

Primary health organizations receive additional per-capita funding to improve access (especially for low-income and vulnerable populations) and to aid in promoting health, coordinating care, and providing additional services for people with chronic conditions. In some cases, this support has led to the development of multidisciplinary care teams that may include specialists, such as nutritionists or podiatrists.

Primary health organizations also receive an incentive-type payment, up to 3 percent in additional funding, that can be shared with GPs who reach recommended targets for disease screening and follow-up, as well as for vaccinations.

GPs have an average income of NZD 180,000–200,000 (GB£ 92,800 - 103,500) per year. GPs who own their own clinics earn more.

After-hours medical care

The funding contracts of GPs require that they provide after-hours care for their patients or arrange for its provision by others. They  receive a separate government subsidy for doing so, which is a higher per-patient rate than the general capitation rate.

In rural areas and small towns, GPs work on call; in some of these areas, a nurse practitioner with prescribing rights may provide first-contact care.

In cities, GPs tend to provide after-hours service on a roster at purpose-built, privately owned clinics in which they are shareholders. These facilities employ their own support staff, such as nurses, but patients usually see a GP in the first instance. Patient charges at these clinics are higher than those for services during the day (except for most children under age 13, who can get free after-hours GP services). Consequently, some patients will visit a hospital emergency department instead of after-hours clinics or avoid after-hours services altogether.

A patient’s usual GP routinely receives information on after-hours encounters.

The public also has access to the 24-hour, seven-day-a-week phone-based “Healthline,” staffed by nurses who provide advice in response to general health questions. The “Plunketline” provides a similar service for child and parenting problems.

Specialist Medical Care

Most specialists are employed by Te Whatu Ora Health New Zealand to work in the public hospitals and receive a salary at a level determined by negotiated national pay scales.

The average public hospital specialist salary range is NZD 190,000 - 270,000 (GB£ 98,000 -  139,217) and additional payments are made for overtime work. Thereby, specialists in public hospitals make about 1.1 to 1.3 times the income of GPs.

Specialists are also able to work privately in their own clinics or treat patients in private hospitals, where they are paid on a fee-for-service basis. Many specialists are based in multispecialty clinics but work independently, renting their office from the clinic.

Private specialists are concentrated in larger urban centers and set their own fees, which vary considerably; insurance companies have little, if any, control over those fees. Insurers pay private specialists only up to a maximum set amount, with patients liable for any difference.

Patients pay the full cost of private specialist visits up front, unless the service is funded by the Accident Compensation Corporation or by private insurance. In the latter case, patients may seek reimbursement from their insurer, or there may be no direct patient charge if a specialist or private hospital holds a contract with the insurer.

Hospitals

New Zealand has a mixture of public and private hospitals, but public hospitals constitute the majority, providing all emergency and intensive care.

Public hospitals receive a budget from their owners, Te Whatu Ora Health New Zealand, based on historic utilisation patterns, population needs projections, and government goals in areas such as elective surgery. The budget includes the costs of health professionals and other staff, all of whom are salaried. Within a public hospital, the budget tends to be allocated to the various inpatient services using a case-mix funding system, although some services are funded regardless of case mix.

A proportion of district health board funding for elective surgery is held by the Ministry of Health, and payments are made on delivery of surgery. Following a pay-for-performance-type scheme, payments can be withheld if a hospital does not meet elective targets.

Certain areas of funding, such as mental health, are “ring-fenced”; hospitals must spend the money on a specified range of services.

Private-hospital patients with complications are often admitted to public hospitals, in which case the costs are absorbed by the public sector. Public-hospital services are provided largely by consultant specialists, specialist registrars, and house surgeons.

Psychiatry

Te Whatu Ora Health New Zealand delivers a range of mental health services including acute inpatient, and community-based services, old age psychiatry, child and adolescent psychiatry, liaison psychiatry, substance abuse and addictions services, forensic psychiatry and learning disabilities.

Services are delivered from hospitals and community and school clinics throughout the country by mental health teams comprised of a mixture of disciplines lead by psychiatrists. Clinical psychologists, social workers and psychiatric nurses are included in the mental health teams. Services have been recently redesigned for improved patient access and effectiveness.

Most patients access mental health care via GP referral to community-based primary mental health services and hospital specialist secondary care services. There are some non government providers of community-based services. Private provision in psychiatry is limited.

Long-term Care and social supports

Public funding for long-term care is based on a patient needs assessment, age, and means-testing. Services are funded for those over age 65 and those “close in age and interest” (e.g., people with early-onset dementia or a severe age-related physical disability).

Eligible individuals receive comprehensive services, including medical care and home care. Respite care is available for informal or family-member caregivers and, in some circumstances, ongoing financial support is provided.

Residential facilities, mostly private, provide long-term care. Public hospitals also provide hospital- and community-based palliative care. Around 33 percent of people over age 65 who receive support live in some form of aged residential care, with the remainder receiving home-based services.

Disability support services for those under age 65 are purchased directly by the Ministry of Health. Some disabled people opt for individualized funding, which enables disabled people to directly manage their disability supports.

End-of-life care in New Zealand is provided in a range of settings, including hospitals, a network of hospices, aged residential care, and the individual’s home.

Long-term care subsidies for older people are means-tested. Individuals with assets over a given national threshold pay the cost of their care up to a maximum contribution. Those with assets under the allowable threshold contribute all their income, except for a small personal allowance. Public funds cover the difference between a person’s payments and the contract price for residential care.

For people in their own homes, household management (e.g., cleaning), which accounts for less than one-third of home support funding, is income-tested. Personal care (e.g., showering) is provided free of charge. Home care services are all provided by nongovernment agencies.

The Future of Health

On July 1 2022, New Zealand began its healthcare transformation disbanding the 20 district health boards and merging them into the single system of Te Whatu Ora Health New Zealand with the stated purpose of creating an equitable, accessible, cohesive and people centred system to improve the health and wellbeing of all New Zealanders.

• People-centred: a system that brings together the voice of all communities
• Equitable: a system that focuses on working in partnership with Māori and honouring Te Tiriti o Waitangi
• Accessible: a system that offers more equitable, convenient and integrated access to services for all New Zealanders
• Cohesive: a national health system that delivers locally, supported by co-ordinated planning and oversight

The new health system has been designed to enable a nationally planned, regionally delivered and locally tailored service which will reduce the pressure on specialist and hospital care and shorten waiting lists for elective surgical procedures and medical treatments. 

Digital technology is integral to the transformation with the roll out of electronic patient records and telemedicine.

Working in New Zealand's Healthcare Sector

New Zealand has shortages of medical and healthcare professionals with opportunities to secure permanent , fixed term contract and locum employment throughout the country.

We note strong demand for the following:

• physicians - specialists, GPs, junior doctors (residents)
• nurses - registered general and psychiatric nurses
• clinical psychologists
• anaesthesia technicians
• physiotherapists
• radiographers
• pharmacists
• medical laboratory scientists

Doctors who are interested in working in New Zealand are invited to  register a CV and contact us to discuss opportunities. Advertised jobs can be viewed on our website and applications made by uploading a recent CV which addresses the eligibility criteria for the job.