Overseas visitors' giant-sized health bill puts DHBs under pressure
Taxpayers are forking out tens of millions of dollars a year treating sick foreign visitors.
About a third of their multimillion-dollar bill is being written off as bad debt, putting further strain on the country's health sector.
In one case, a foreign visitor treated at Waikato Hospital in 2015 ran up a $107,669 bill after needing acute surgery.
Records obtained under the Official Information Act show between January 2013 and October 2016, district health boards spent about $160 million on patients ineligible for public healthcare.
* Unpaid medical bills in Nelson Marlborough top $380,000
* Foreigners cost MidCentral DHB $1.7 million for healthcare
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About $51m of that bill has been written off since January 2013.
The issue of overseas nationals accessing public healthcare came under the spotlight in Australia recently after a 17-year-old New Zealander was assaulted outside a Brisbane McDonald's.
The family of Joshua Waite set up a Givealittle page to help with his costs since, as a non-Australian citizen, he wouldn't receive any medical benefits.
In general, when patients receive treatment in New Zealand but prove to be ineligible for public healthcare, an invoice is raised and the patient followed up for payment.
If payment isn't received, the account is handed over to debt collectors.
Green Party health spokeswoman Julie-Anne Genter said it would be a bad look if overseas visitors were turned away from New Zealand hospitals.
However, the government has to ensure the health system is sustainable. There is merit in encouraging foreign visitors to take out travel health insurance.
Genter grew up in the United States and always buys a travel policy when returning to visit family.
"Our public health system is something we want to protect and cracks are starting to show," she said.
"I think it's worth at least investigating the idea of promoting health insurance to people who are visiting New Zealand, whether that's done through airlines or other travel sites."
Further analysis is needed to determine where ineligible patients come from and in what numbers.
"We could use this information to investigate opportunities that could benefit New Zealanders travelling to those countries," Genter said.
The ability of district health boards to collect debts also needs strengthening.
All overseas visitors are entitled to free emergency care for injuries caused by an accident. Ongoing treatment may be paid by ACC.
Lesley Immink, chief executive of Tourism Export Council New Zealand, said visitors from North America, Europe and the United Kingdom typically have medical insurance.
This isn't true for tourists from Asia and emerging markets.
Immink said introducing a medical tax as a means of covering tourists' health costs could damage the country's reputation and might be perceived as "milking" overseas visitors.
She favours encouraging overseas visitors to take out medical insurance.
"I'd hate to see that we end up like the United States, where they don't serve people if they don't pass their medical insurance card over."
Between January 2013 and October 2016, Waikato DHB spent $5,174,577 treating ineligible patients. About $1.37m of that debt has since been written off.
In 2014, Counties Manukau DHB treated an acute overseas burns patient who was not eligible for publicly funded healthcare. The total cost of treatment was $522,513.
Counties Manukau DHB receives funding from the Health Ministry to compensate it for a portion of the bad debts it has to write off each year.
Hamilton & Waikato Tourism chief executive Jason Dawson doesn't favour a health levy being applied at the border, saying it would impact everyone when the issue only applies to a minority of overseas visitors.
Making it compulsory for foreigners to take out health insurance could also affect New Zealanders when travelling overseas.
"It would be interesting to see how much New Zealanders rely on public health services when we go to certain countries that don't require health insurance," Dawson said.
New Zealand Taxpayers' Union executive director Jordan Williams said district health boards need to make every effort to recoup the medical care debt.
Current efforts to recover the debt is "very poor", given about a third is written off.
"Compulsory health insurance would be preferable to a levy, but the most obvious thing to do is to do a better job at recovering the amount owed.
"Many foreign health agencies require passports to be surrendered at the time of treatment to ensure payment before the patients depart. Maybe it is time our DHBs seriously consider this."
WHO GETS FREE HEALTHCARE?
- Permanent residents, citizens (including people from the Cook Islands, Niue and Tokelau) and Australians who have lived or intend to live here for at least two years are eligible for free healthcare
- Those on a two-year or more work visas, refugees, Commonwealth scholarship students, some New Zealand Aid programme students
- Children aged up to 17 whose parents are eligible
- British and Australian tourists if they fit reciprocal agreement criteria
- Foreigners who can prove they meet criteria. It is up to health providers to check whether patients are eligible
- Source: Health Ministry
- Sunday Star Times