Healthcare in NZ is a Hybrid model | Protection Solutions

Healthcare in NZ is a Hybrid model

Healthcare in NZ is a Hybrid model

April 26th, 2022

Emergency medicine is covered under the state system, if you have an accident the care is provided by the state system but paid for by ACC.  If you want elective surgery then you must pay for this, and this is through what is called the private system.

Now the state system, which is your local District Health Board, underwrites the Private system. That is if it all goes wrong in the private hospital then they will care for you in your local hospital. As the private system does not provide critical care services.

I am sure that’s as clear as MUD……

Let’s sum it up:

  • Have an accident rushed to accident and emergency cost covered by ACC
  • Have a heart attack rushed to accident and emergency, cost covered by the Government
  • Need your tonsils removed and it’s not an emergency? Then either join the queue to get seen in a public hospital or go to a private faculty and pay through your own means or health insurance.

    Which one of the above will happen to you, well now that is the challenging part?

And then the lottery of which DHB you are in starts another debate as many have different service standards.

Now the 20 District Health Boards are moving into one new National Health service over the next few years. If anyone has been part of a merger or an acquisition, then the services are likely to change and generally for the short term, not for the better. The mergers will take over management time and focus.

What new and exciting healthcare changes are coming?

Putting aside the merger of the DHBs and the fact services are changing we are also at a watershed time for healthcare improvements.

So, what are some of the new stuff heading our way?

Cancer Care: 10 to 15 years ago just about all cancer care was in the State System, now more are done privately or as a combination of both. Most major cities now have private cancer facilities available.

Alzheimer’s Care: New tests are showing that you can diagnose Alzheimer’s at a very early stage, this will lead to intervention and new forms of care

Obesity: There is a trial going on in the UK for a new drug for Obesity-related weight. Semaglutide is a weekly injection that shows around a 12% weight loss after 12 months.

Regenerative Medicines: Growing new tissues in a lab or regenerating them in the human body. This will seek to replace tissue or organs that have been damaged by disease, trauma, or congenital issues, vs. the current clinical strategy that focuses primarily on treating the symptoms.  

There are numerous global tests going on now for these medical improvements.

Cancer Immunotherapy: Using BIG DAT sets to develop cancer care based on previous success using different drugs and medications.

Gene Editing: Going into the base human Gene and changing them to help fight disease, by 2030 this is expected to be common. There are currently around 6500 diseases but cures for only 500, this will allow work on the ones currently not able to be cured.

Precision Medication: Medication for one, diagnosis, treatment, and healthcare for each unique human. Again, using data to create a healthier you.

Who is Going to Pay?

We already seriously underfund our health system. The country’s health system is overstretched, underfunded and inequitable with District Health Boards ending the financial year $874 million in the red. The assessment is part of the Ministry of Health’s briefing to its incoming minister, Andrew Little, released on Tuesday.15/12/2020

To fund the new healthcare that is coming, you will need to be able to pay before it becomes mainstream. There are a couple of ways to do this, be wealthy enough to pay your own way, use Pledge Me websites such as the Give a Little page or have really good health insurance to cover the cost.

Health care and the future

There is a move with some health insures to cover you near the top of the cliff. NIB has been trailing bowel screening for some of their clients, they have weight loss assistance for clients identified as having high BMI, ability to access mental health services and a lot more. There will be more and more of this type of assistance going forward. Finding an issue early will have much lower long-term costs and help keep premiums down.

ACCURO have access to Best Doctors and on some plans access to mental health services. Southern Cross has been offering low-cost online access to GP visits.

So, what’s the Big Concern?

The DHB merger and setting of a separate Māori Health Authority will take many, many millions of dollars, and manhours, during this time some services will surely fall between the cracks:

  • Mergers take the management eye off the ball, more often than not
  • Future health care will come at a cost, who is going to fund it
  • Pharmac who pays for most of our medicines is already underfunded, what’s going to change
  • The Pandemic has already reduced services across the board


You need health insurance make sure it has high limits for the new healthcare interventions coming our way. Contact us if you have any questions about what is covered in your policy.