JANUARY

NEW ZEALAND
Administrative mechanisms for paying primary care doctors and specialists: As noted above, GPs’ income
is derived from government subsidies, which include payments from the Accident Compensation Corporation
(ACC), and from patient copayments. Some patients subscribing to private insurance may be eligible to claim
for the copayment. Patients pay the full cost of private specialist visits up front, unless the service is funded
by ACC 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.
After-hours care: GPs are required in their funding contracts to provide after-hours care or to arrange for
its provision, and receive a separate government subsidy for doing so, which is higher per patient 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 (although 95% of children under age 13 can
have access to free GP after-hours services). Consequently, some patients will visit a hospital emergency
department instead, or avoid after-hours service 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. “Plunketline”
provides a similar service for child and parenting problems.
Hospitals: New Zealand has a mix 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, the DHBs,
based on historic utilization patterns, population needs projections, and government goals in areas such as
elective surgery. The budget includes the costs of health professionals and other staff, who are all salaried.
Within a DHB hospital, the budget tends to be allocated to the various inpatient services using a case-mix
funding system. A proportion of DHB funding for elective surgery is held by the Ministry of Health, and
payments are made upon delivery of surgery. Certain areas of funding, such as mental health, are “ringfenced”—the
DHB must spend the money on a specified range of inputs.
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.
Mental health care: Most people get access to mental health care through primary mental health services
in the community, often through their GP, who will then coordinate any referred services, but also through
school-based health services and community services provided by nongovernment agencies, which are all
publicly funded. DHBs deliver a range of mental health services (including secondary services), such as forensic,
acute inpatient, and community-based services, and provide support to primary care providers; they also fund
nongovernment providers of community-based services. Private provision is limited.
Long-term care and social supports: DHBs fund long-term care for patients on the basis of needs assessment,
age, and a means test. They fund services 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). Those eligible receive
comprehensive services including medical care; many older or disabled people receive home care. Some
younger disabled recipients opt for individual budgets to arrange their own home care. Respite care is available
to relieve informal or family caregivers, and in some circumstances there is ongoing financial support.
Residential facilities, mostly private, provide long-term care. DHBs also provide hospital- and community-based
palliative care. A network of hospices provides end-of-life care, with approximately 70 percent of funding
coming from DHBs and the remainder through fundraising. Palliative care is also provided in the community.
Long-term care subsidies for older people are means-tested. Residents with assets over a given national
threshold pay the cost of their care up to a maximum contribution. Residents with assets under the allowable
threshold contribute all their income, except for a small personal allowance. DHBs cover the difference between
the resident’s payments and the contract price for residential care. For people in their own homes, household
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