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New Zealand Health System - what you might pay for healthcare

About healthcare costs

The care provided by family doctors or general practitioners (GPs) is partially subsidised by the government but in most cases you will still need to pay a copayment. This fee is set by the GP and can vary from clinic to clinic.

Most New Zealanders are now enrolled with GPs who are part of a Primary Health Organisation (PHO). Being enrolled in this way usually means the GP can provide cheaper visits and services to those patients. Some practices may also provide free standard consultations for children under six years (after-hours charges may still attract a cost) - ask your local practice if they are part of this scheme.

If you are a beneficiary or are on a low income, you may be eligible for a Community Services Card, or CSC. A CSC can entitle you to additional healthcare subsidies. Your doctor or practice nurse can tell you if you qualify, or you can call Work and Income on freephone 0800 999 999.

The same applies to people who use health services often and have long term illnesses. These people may be eligible for a High Use Health Card (HUHC), which allows subsidised healthcare. [There is more information on the CSC and HUHC further below.]

The nurse at your GP's practice may provide some services at lower cost than the GP. Ask about cervical screening, blood pressure checks, injections and other procedures that can be carried out by the nurse.

Eligibility for publicly funded services

If you are not a New Zealand citizen or permanent resident, you can check your eligibility for publicly funded health services on the Ministry of Health's website. Also see the Department of Internal Affairs' website for passport/ citizenship information.

Dental care

Basic dental care for New Zealand children and adolescents is free up to 18 years of age. However, some specialised treatments will not be covered by this service, such as orthodontics (braces). To enrol your child or teenager in the Community Oral Health Service, or to view resources about protecting your family's teeth see www.letstalkteeth.co.nz or freephone 0800 825 583. You can also use this phone number to ask questions or get advice on oral health.

Most people aged 18 years and over will have to pay the cost of their own dental care. District Health Boards in some areas may provide limited dental services, usually for eligible people on low incomes (this may mean having a Community Services Card). Some hospital dental outpatient departments may provide emergency pain relief and tooth extraction for people on low incomes (usually CSC card holders). A part charge or fee may still be payable. Work and Income New Zealand may provide financial assistance for urgent dental care for some beneficiaries/CSC card holders. Dental care required due to accident or injury may be covered by ACC [see Accident treatment further below]. 

Pregnancy and childbirth services

Care in pregnancy and childbirth is mostly free or subsidised for New Zealand citizens and permanent residents, or for their partners or wives, except for care provided by private obstetricians and at private hospitals. There may also be charges for antenatal or childbirth education classes, some laboratory tests and ultrasound scans. Pregnancy care includes antenatal, labour, birth and postnatal services.

>> You can ask questions, get recommendations and talk with other parents and mums-to-be in our everybodyCommunities pregnancy forums. 

Women who are not eligible for publicly funded health services may be charged for antenatal, labour, birth and postnatal services provided to them. Also, babies born from 1 January 2006 will only be eligible for New Zealand citizenship if at least one of their parents is a New Zealand citizen or permanent resident. If you are not eligible for publicly funded maternity services and your baby is not eligible to be a New Zealand citizen, you will also pay any costs for your baby.

Termination of pregnancy (abortion)

District Health Boards are required to purchase abortion services, which are free of charge to the woman if she is eligible. A woman has to be eligible in her own right (ie, not through her partner/husband's citizenship status) for an elective termination of pregnancy (abortion) to be publicly funded. However, if the termination of pregnancy is due to, for example, foetal abnormality, the abortion may be publicly funded. These services can be provided locally or, sometimes, outside your area. Contact your GP, midwifery centre or local family planning clinic for more information.

Specialist and hospital care

If your GP refers you to a specialist or hospital you can choose to go publicly or privately. Almost all essential medical services are provided free through the public health system (excluding ^dentistry and #optometry).
^See 'Dental care' above for details of care for under 18s.
#Some children under 15 years with vision problems may be eligible for the Subsidy for glasses and vision tests

If you go privately for medical services, you must pay. If the doctor suggests a private specialist or hospital, but you would prefer to use public services, ask for a public referral. You can contact the public service yourself and ask about waiting times in your area. There are wide variations in waiting times depending on location and type of service required. Don't assume that you will "never be seen in time". Private specialists and consultants charge for their services. Some services are only available publicly (such as radiotherapy) but you can still see a specialist privately. [Also see 'Health insurance' further below.]

Accident treatment

Treatment for accident-related injuries is subsidised by the Accident Compensation Corporation (ACC), as long as this care is provided by a registered health professional. There may be a user part-charge for visits to GPs, or for physiotherapy, chiropractic and other recommended treatments. Claims for ongoing treatment have to be accepted by ACC and part charges may apply. Visitors are recommended to have comprehensive travel insurance to cover the cost of expenses not covered by ACC.

Laboratory tests and x-rays

Mostly, laboratory tests and x-rays are free. But private radiology clinics charge for all tests undertaken - unless they have been contracted to provide them by a local District Health Board service. Breast screening is free for women between the ages of 45 and 69 years of age (who enrol in the breast screening programme). Cervical screening is free for women aged 20 years or more and under 70 years who have ever been sexually active.

Blood tests are mostly funded by the District Health Board and will not usually cost you any money.

Drugs or medications

Some medicines are subsidised for patients in New Zealand. Pharmac, a government organisation, specifies which medicines will be subsidised (these are the medicines on the Pharmaceutical Schedule).

Prescription medicines: Adult New Zealanders enrolled with a doctor in a PHO (Primary Health Organisation) will usually pay $5* per item for subsidised medicines from a community pharmacy. However, this may cost up to $15 if the prescription is from a specialist, or if the prescription is not from the doctor they enrolled with. Prescription medicine for children under six years is usually free. For some medicines you also pay an extra part-charge. Some drugs are not subsidised at all, and must be fully paid for. Your doctor can tell you if a drug has an extra charge or is not subsidised.

*Note: The prescription charge for subsidised medicines was increased from $3 per item to $5 per item from 1 January 2013. The charge applies to a maximum of 20 prescription items per person or family per year (calculated from 1 February each year), after which there will be no further prescription charges for that person or those family members until 1 February of the next year. For more information on this see the Pharmaceutical Subsidy Card further below.

Non-prescription medicines: Non-prescription (over-the-counter) medicines must be paid for in full.

People who live in households with low incomes or which have high healthcare needs can apply for a Community Services Card (CSC) or High Use Health Card (HUHC). CSC or HUHC allow adults and older children to pay a lesser charge per item for medicines and nothing for children under six years. 

Eligibility for Community Services Card

The Community Services Card (CSC) is available to low income individuals or those receiving a benefit, and their dependent family members. Eligibility is based on family size and income. Phone the Community Services Card national centre freephone 0800 999 999 for more information or visit www.workandincome.govt.nz 

Eligible senior citizens and veterans will receive a combined SuperGold Card/CSC - see further below for details.

Eligibility for High Use Health Card

The High Use Health Card (HUHC) gives an individual access to a higher government subsidy on visits to the doctor. To be eligible for this card an individual needs to have visited the doctor 12 or more times in one year, with the consultations being related to a particular condition, or condition(s) which are ongoing. This card is not means tested. Your doctor will have a record of your visits, and he or she has to make the application for your HUHC. A HUHC lasts for one year, after which time a new application can be made (if appropriate).

The HUHC gives the same amount of subsidy as the Community Services Card on GP visits and prescription charges. (If you already have a CSC, there is no advantage in having a HUHC because the subsidy is the same.) However, if you already have a HUHC, there is an advantage in also having a CSC, because the CSC gives subsidies to all dependent family members, while the HUHC is only for an individual.

  • Adults with a HUHC get a subsidy of $15 for a visit to a doctor.
  • Children aged 6 to 18 years get a subsidy of $20 for a visit to a doctor.
  • For prescriptions, the government prescription charge is reduced (but when the medicines themselves are only partly subsidised there will still be additional charges).

Pharmaceutical Subsidy Card

The Pharmaceutical Subsidy Card (PSC) allows the cardholder and named family members to pay a lower amount on the government prescription charges – by capping the number of prescriptions that must be paid for by a person or family to a total of 20 items per year. The year for this purpose is calculated from 1 February.

There is no income testing. The purpose of the card is to help people who face high prescription costs.

The easiest way to get a PSC is to use the same pharmacy each time for your prescriptions, as they will automatically keep a count of your prescriptions, and issue a PSC once the total of 20 items is reached (if this occurs in the 12-month period starting from 1 February in any year). Once this occurs, the person or eligible family members will not need to pay the prescription charge on any further subsidised medicines until 1 February of the next year. Advise your pharmacist of family members’ names and ages who should be placed on the same family unit (includes dependent children). If unsure who is eligible to include, ask your pharmacist.

If you use a number of different pharmacies, keep your prescription receipts until you have a total of 20 items (in a 12-month period from 1 February any year), and take this into a pharmacy, who will issue you with a PSC. More on the PSC.

SuperGold Card

The SuperGold Card is available to eligible senior citizens and those on the Veteran's Pension. The SuperGoldCard offers discounts on some services such as public transport. People who are entitled to receive a Community Services Card at the time of qualifying for NZ Superannuation ('Super'), will be eligible for a combined SuperGold Card/CSC. The combined SuperGold Card entitles the person to the same health subsidies as the Community Services Card. Holders of a SuperGold Card need to present this card to receive subsidies. More information can be found on www.supergold.govt.nz

Other services

  • Independent nurse practitioners charge for their services, except when they are contracted to hospitals or DHBs to provide free or partly subsidised services. 
  • Physiotherapists, osteopaths and chiropractors will charge you. This may be a part-charge if your doctor has referred you. 
  • Complementary or natural therapy is not subsidised so you must pay for the whole service, unless that care is being provided by a practitioner who is also a doctor or midwife. For example, some doctors provide acupuncture and homeopathy services. 
  • Long-term residential care for older people is asset-tested. To find out what you are entitled to, contact the local branch of New Zealand Income Support Service. 

Ambulance treatment and transport

Ambulances are provided by non-profit community-based services in most parts of New Zealand, as well as hospitals and private providers. There is a patient part-charge in the region of $65-$80 depending on area, for emergency ambulance treatment and/or transport. There is no charge for the Wellington Free Ambulance. ACC may pay the charge for ambulance transport if it is for an accident-related injury that is covered by ACC (and ambulance used within 24 hours of the injury and the injury meets ACC criteria).

In some situations District Health Boards may pay the cost of ambulance transport (eg, if the DHB wishes to transfer you to another hospital). People who order an ambulance for non-urgent medical transport are charged according to the distance travelled, with a minimum fee of $145 (as at January 2013).

Visitors to New Zealand who are not eligible for publicly funded healthcare services are charged a flat rate for ambulance use ($757 as at January 2013).
More information on ambulance charges

Health insurance

Health insurance entitles those insured to get refunds for specific health services. The size of the refund and the services covered depends on the policy. There is often a shortfall between the amount of the refund and the actual cost of the service. While this sum may be small for some services (for example, a visit to a GP), for major surgery the shortfall may be very large.

As some health services are only available in public hospitals, health insurance may be of no benefit in particular circumstances. Many cancer treatments, intensive care and major trauma and accident treatments are examples of services not provided by the private sector. See our topic Making Sense of Health Insurance.

Non-New Zealand residents

Health services are funded for New Zealand residents. People who are not permanent residents can be charged for their healthcare. Nobody can be refused emergency care because they cannot pay, although they may be sent a bill later.

Treatment after an accident is free or heavily subsidised for all people whether or not they are New Zealand residents. Accident-related treatment is covered by the Accident Compensation Corporation (ACC), but visitors to New Zealand are recommended to have comprehensive travel insurance to meet the costs of expenses that ACC does not cover (including repatriation).

Arrangements for reciprocal healthcare for some services may be available to people who are residents of specific countries, eg, Australia. If you are not sure whether you are eligible for publicly funded healthcare, you can contact the Ministry of Health or visit the Ministry of Health's website page on Eligibility for Publicly Funded Health and Disability Services.

Registration

New Zealand has no compulsory system of registration to receive healthcare. However, many New Zealanders who have used health services have been automatically registered on the National Health Index (NHI) and have been allocated an NHI number.

There are a number of other registers: The National Cervical Screening Programme has a register for women aged 20 to 70 years, which can be used only for cervical screening (freephone 0800 729 729) or see www.cervicalscreening.govt.nz

BreastScreen Aotearoa offers a free breast cancer screening programme for women aged 45 to 69 (freephone 0800 270 200) or see www.breastscreen.govt.nz

Some GP practices keep practice registers. This information should be confidential to the providers involved in your care. If information about you is to be passed on to any other agency, you must be told of this when the information is collected.

Your privacy

Under the Privacy Act 1993, you have a number of rights with regard to health information held about you. In general, you have a right to see that information.

If you have concerns about the privacy of your health records you can phone the Office of the Privacy Commissioner on freephone 0800 803 909 or if you live in Wellington area (04) 474 7590. You should be able to ask for an interpreter, if needed, when phoning the office. You can also email on: enquiries@privacy.org.nz or visit the website of the Office of the Privacy Commissioner.

Health And Disability Commissioner

The 1994 Health and Disability Act is expressed as being "to promote and protect the rights of health consumers and disability services consumers, and, in particular, to secure the fair, simple, speedy, and efficient resolution of complaints relating to infringements of those rights" (s 6). This objective is achieved through the implementation of a Code of Rights, the establishment of a complaints process to ensure enforcement of those rights, and the ongoing education of providers and consumers.

Complaints about the health services you receive can be directed to the Health and Disability Commissioner - freephone 0800 11 22 33, website www.hdc.org.nz. See the Code of Health and Disability Services Consumers' Rights

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Original material supplied by everybody. Information updated February 2013.

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