Foreigners have received just over $204.4 million worth of hospital treatment in the past five years. Photo / Getty Images
New Zealand needs to stop being a "soft touch" when it comes to non-residents' unpaid hospital bills, a Rotorua health sector leader says.
Foreigners have received just over $204.4 million worth of hospital treatment in New Zealand in the past five years, with taxpayers left to foot the bill for about a third of that between July 2015 and June 2020, excluding GST.
That's according to data provided by all bar one of New Zealand's 20 district health boards.
In the Lakes District Health Board area, non-residents have received about $2.09m worth of hospital treatment between mid-2016 and October 2020.
Just over $96,600 - less than 5 per cent - was written off as bad debt.
The biggest individual patient bill was $87,508, including "medical with theatre and a long stay".
Non-residents are not eligible for publicly funded care in New Zealand but hospitals will provide emergency or urgent care and bill the patient afterwards. Injuries caused by accidents are paid for by ACC regardless.
Lakes DHB member Merepeka Raukawa-Tait said New Zealand health services were for New Zealand citizens.
Raukawa-Tait - also a Rotorua Lakes councillor and Whanau Ora chairwoman - said no non-resident in need of healthcare would be turned away, but they should be "prepared to pay for any health services they receive".
"That's why whenever Kiwis travel we are encouraged to take out medical insurance.
"I know that in many countries hospitals won't even look at you without seeing proof of medical insurance."
New Zealand did not have unlimited health dollars and, in her view, non-residential visitors should agree to pay before being treated.
"I believe the Ministry of Health should develop and put in place nationwide guidelines for DHBs to ensure medical procedure costs are made known to non-residential visitors seeking care. Payment to be agreed to, before medical care is provided."
She said every visitor had a credit card or could get money transferred from home to cover unexpected costs.
"At present every DHB goes it alone. Some are more successful in recovering unpaid medical bills than others. A consistent, successful approach would be best.
"No DHB can afford to write off bad debt. New Zealand should stop being a soft touch."
Paora Stanley, chief executive of Ngāi Te Rangi, an iwi that runs a free mobile clinic in Tauranga, said humanity had to be the first principle, over money.
He said he once fell badly ill overseas before his health coverage kicked in and "could have died there because I could not get access to meds".
In his view, it was okay if people fell ill while visiting New Zealand even if they ended up burdening the taxpayer.
"Let's stick to first principles: look after people and don't care where they come from."
Kiwis were happy to take tourists' money, so when they needed help we should give it and "sort the rest of it out later", Stanley said.
He queried how many Kiwis travelled overseas without medical insurance, but would still expect treatment if they needed it.
In his view, the amount of debt written off was "not a lot" in the context of New Zealand's health budget of over $20 billion for 2020/21 alone.
Health Minister Andrew Little said the debt was "the cost of being a compassionate country" and a "relatively modest one at that".
"We've all seen stories about the plight of New Zealanders who fall ill in countries that have less compassionate health services than us. I'd like to think we're better than that."
Little said New Zealanders shouldn't worry that the cost would affect health services available to them because there was a process for the Ministry of Health to compensate DHBs for treatment costs they had to write off.
"Nevertheless my expectation is that DHBs pursue every reasonable opportunity to recover money owed to them following treatment of ineligible patients," he said.
All DHBs said letters and phone calls, both local and international, were used to follow up unpaid invoices but outstanding payments were eventually referred to debt collectors and written-off as bad debt.
A Ministry of Health spokesman said it was important anyone needing emergency care could get it which inevitably led to bad debt because some patients could not afford to pay while others could not be traced.
Regarding the rising cost of treatment, he said costs incurred by DHBs were increasing independent of patient numbers, but it was also likely the number of ineligible patients seeking treatment was going up.
The spokesman said government advice was that travellers obtain comprehensive travel insurance if they are not eligible for publicly funded health and disability services.
"In most cases, DHBs only provide services to ineligible people [those not covered by the eligibility direction] where they present acutely or in an emergency situation.
"DHBs are expected to use their best endeavours to recover the costs of treatment for ineligible people."
The Lakes District Health Board was also contacted for comment.
"Too lenient" - immigration adviser's view
Some commentators have said to reduce the debt the Government should look at making visitors prove they have full health insurance.
Other suggestions included not allowing people in poor health to visit, refusing a visa to anyone with an outstanding debt and forging no-charge reciprocal healthcare agreements with other countries.
Navdeep Kaur, licenced immigration adviser and co-owner of Genuine Immigration, said she believed New Zealand's policies in this area were "too lenient".
"I strongly agree there should be requirements imposed to have appropriate insurance cover for all travellers as it is the case in many other countries, such as Australia."
This would reduce pressure on the health system and the taxpayer's burden, she said.
"Even a healthy person can fall sick anytime."
But, in her view, it would be unfair and inhumane to stop people with poor health travelling to New Zealand to see loved ones or for leisure.
Kaur, who is based in Tauranga but has had clients further afield, including Rotorua, said more should be done to hold to account people who sponsored a relative or friend's visa and agreed to look after the entrant's welfare.
"In reality when an unfortunate situation arises, they will just back off and not pay the medical bills which contribute to unpaid debts."
In her experience, many travellers did not get medical insurance because of the cost or perceived hassle of getting a payout. New Zealand insurance companies tended to be more responsive but few provided insurance to visitors, she said.
"We have seen situations where visitor visa holders were hospitalised and had heavy medical bills but luckily they had insurance cover by a New Zealand insurance company so it was paid off.
"On the other hand, we have clients who just ignore it. When they need medical care they create financial pressure on their families and end up in bad debt and then they accuse our healthcare system of not looking after visitors, which is completely not correct."
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