The funding was discussed at a recent board meeting. Chief executive Ailsa Claire told members that 50 per cent of the service provided to non-residents wasn't priced correctly, and "therefore the Auckland population has been cross subsidising the rest of the country".
According to minutes from the meeting, board chair Pat Snedden said the situation meant "the Auckland local population misses out which is not fair".
"However, the Government has determined that as all DHBs are in deficit to ask for more from them is not seen as sustainable in the overall health finding scenario. There needs to be a reset in the technical pricing differential but in the meantime we are instructed to be as efficient as we can with what we have."
The worry about funding at the December meeting will have only increased, after the recent arrival of Covid-19 coronavirus. Hospitals are braced for the possibility of a large number of people needing urgent care, and in winter when they are already at capacity.
Asked what patients were missing out on, an Auckland DHB spokeswoman said Snedden was talking about community health initiatives.
"What our chairperson is referring to in the minutes is our ambition to invest more in equity of outcomes and preventative care to keep people healthy in the community. This is a challenge when balancing spending on hospital care, but we are ambitious to increase investment in these areas.
"Our board, committees and leadership team are in regular discussion about this balance. No government can afford to fund everything they want to, therefore funding priorities and where they sit are a mixture of government priorities and what is negotiated with each individual DHB, and Auckland DHB is no exception.
"When you provide high-end specialist services for people who live outside of a DHB area there is always a tension around pricing and costs...we are proud of the care we provide to all patients, wherever they reside."
The Auckland region has three DHBs - Auckland serves central suburbs , Waitematā covers West and Northern areas, and Counties Manukau in the South, including Pakuranga.
Last year the Herald revealed ADHB raised serious concerns with the Ministry of Health about women living outside its boundaries from using its facilities for booked inductions and caesarean sections.
The DHB briefed ministry officials on the numbers of non-resident women using secondary birthing facilities - between about a third and 50 per cent on any given day.
"Auckland DHB has a duty of care to its resident population and also to provide a safe and sustainable working environment for its employees," a ministry official later summarised. "They know they cannot do that if a third of the people are coming from elsewhere."
How DHBs work together and whether some could be merged is expected to be addressed in a sweeping, Government-commissioned review into the whole health and disability sector. Recommendations from the review are expected this month.
