How the health system works in New Zealand
This resource provides details on how the health system in New Zealand works.
Primary care in New Zealand
In New Zealand, general practice is the primary access point to the health system.
Each New Zealander is expected to be enrolled with a Primary Health Organisation through their local medical centre. The medical centre where they are enrolled maintains their medical record and receives government funding to meet their primary healthcare needs including assisting them to stay well.
In most cases people need to see their general practitioner to be referred to a specialist or to have a laboratory test or an x-ray. Results and reports from these referrals are returned to the health practitioner who initiated the referral.
General practitioners work in business or practices often called medical centres. These practices are commonly owned by some, if not all, the doctors who work there (known as the partners). The practice employs the staff including practice nurses, receptionists and in most cases a practice manager. The owners are paid from the profits that the medical centre makes. Each practice sets its own fees.
Some medical centres are owned by Māori provider organisations, Accident and Medical Groups or community trusts. These organisations will usually employ the doctors.
The health practitioners work together as a team, with each practice deciding what tasks are best done by the doctors or the nurses.
The doctors and nurses in the medical centre will all use the same medical record, so it should not matter who you see. They will all be able to look at the notes from previous visits. Most medical centres in New Zealand now keep their records on a computer.
Clinics may employ locums either to fill gaps when regular doctors are on vacation or when it is difficult to get permanent general practitioners, so may only be working there temporarily.
Role of Primary Health Organisations and District Health Boards
Money for health services is budgeted by the government and given to the Ministry of Health. The Ministry of Health allocates this funding to the 21 District Health Boards. Each District Health Board has one or more Primary Health Organisations which are responsible for funding and coordinating general practice in the region.
The Primary Health Organisation will decide, in consultation with the local population, what additional services their primary care providers should offer. This may range from national programmes such as immunisations and Well Child programmes through to health promotion activities such as stop smoking, sexual health, mental health or weight management. Primary Health Organisations are also responsible for tracking the performance of their member practices and distributing the performance based payments from the District Health Boards.
Each medical centre receives money from the Primary Health Organisation, and this funding comprises 50-90% of the practice income. As the funding does not usually cover the full cost of the visit there is usually an additional fee covered by the patient (including ACC surcharges).
Some practices have joined the Very Low Cost Access scheme which pays a higher rate, but requires them to provide free services for under 6s.
Most practices in New Zealand have around 1,200 patients enrolled for each doctor in the practice. Very few of these patients will be children or young people in care, and so the practice staff usually has a very sketchy understanding of Oranga Tamariki.
Where a person is not enrolled with the practice (casual patient), only a small portion of the government funding is available to that practice. Although there is a process to claim funding from the practice where they are enrolled, many general practitioners find it easier to ask the patient to pay the full cost of the visit.
If the child or young person has a community service card or a high use health card this will help pay for part of the consultation. It is important to bring the card with the child or young person to the medical centre.
Be cautious about enrolling the child or young person with a new practice, unless they are likely to continue to attend that medical centre. A person can only be enrolled with one Primary Health Organisation at a time and it takes up to three months before the funding flows to the practice. Enrolling a child or young person with a practice that is different from where their parents are enrolled will remove the child from the family general practitioner’s register, stop any recalls (for immunisations etc) and mean that the parents pay a higher fee if they take the child or young person to their doctor.
Doctors in general practice
General practitioner's training and expertise
Most doctors in general practice are specialists who have expertise in looking after a wide range of general health conditions that commonly present in the community.
All the health professionals in the medical centre are skilled in general practice, however, each doctor or nurse will likely have his or her own area of special interest. While some general practitioners have a special interest in children and young people, others may be more focused on chronic disease, care of the elderly, sports medicine, work related health, women’s health or areas that are not associated with the health of children or young people.
Nursing roles usually cover immunisations, wound dressing and running clinics for asthma, blood pressure or chronic medical conditions such as diabetes or lung problems. Some nurses have undertaken additional studies to become nurse practitioners and are able to write prescriptions and provide nurse-led services.
If you require a comprehensive assessment or a full medical assessment for a child under two years, you may be best to arrange an appointment with a paediatrician who can check the child’s development, behaviour and the more complex areas of child health.
Paediatricians care for children up to the age of 16.
Accident and medical clinics
Accident and medical clinics specialise in seeing urgent cases. They are usually open for longer hours and often provide clinics on the weekend. They tend to have a high turnover in medical staff and do not usually provide ongoing care, preferring to refer people back to their general practitioner for follow-up.
Because they are geared towards urgent cases, which are best treated in cubicles, some accident and medical clinics struggle to provide rooms suitable for private consultations.
Training and expertise
Most doctors in general practice are specialists who have completed the advanced training programme and passed the exams to become Fellows of the Royal New Zealand College of General Practitioners.
To retain their vocational registration (specialist status) each doctor must be involved in a continuing medical education programme. This usually involves attending conferences and regular education sessions.
Quality and accreditation
Most medical centres in New Zealand are involved in continuous quality improvement programmes. The College of General Practitioners operates a programme called “Cornerstone” which includes a set of standards and regular survey visits to assess how well the practice has implemented the standards.
If you are concerned about the service provided by a doctor or nurse in a medical centre, you should let them know about your concerns. This is best done by writing a letter to the practice manager or to the manager of their Primary Health Organisation. The letter should be quite specific about who the health professional was, the date and what they did that you are concerned about.
If you feel the service provided was very inadequate or dangerous, or if you are concerned that lodging a complaint could damage your ongoing relationship with the medical centre, then you should write your complaint down and contact your local health and disability advocate who will follow-up the issues.