Funding, Functioning and the Future: Aotearoa New Zealand’s Health System

How do we fund our health system – and what kind of system do we want in Aotearoa New Zealand?

In 2025 Toi Mata Hauora ASMS is releasing a series of reports examining the funding and operation of our health system.

For decades, successive governments have failed to adequately fund our health system, leading to entrenched staffing shortages, failing physical infrastructure, and outdated equipment and technology.

The impact of chronic under-investment is growing unmet need, longer waiting times for first specialist assessments and treatment, overloaded emergency departments, poorer health outcomes, and more time spent in ill health.

• New Zealand’s Health Financing and Expenditure by Tim Tenbensel and Paula Lorgelly compares New Zealand’s public health spending to a group of 16 comparable countries and concludes that in the years leading up to the Covid-19 pandemic, the health system was comparatively underfunded by at least $1 billion per year. International comparisons from 2019 onwards are difficult, because the Ministry of Health stopped submitting returns to the OECD.
•  Managed Decline by Andrea Black analyses New Zealand Health Survey data from 2011 – 2024, revealing that the self-reported wellbeing of New Zealanders is getting worse – especially for working aged people. This decline has social costs of between $2.6 and $8.6 billion, and economic costs of between $2.5 and $3.5 billion.
• Fiscal Rules by Ganesh Ahirao posits that Aotearoa’s fiscal settings do enable us to have strong public services and fiscal responsibility – and we need a public conversation about the infrastructure we need, and how we are going to pay for it. The government is not a household, and the Public Finance Act is not a barrier to realising the goals of Health for All.
• Māori Health, Te Tiriti o Waitangi and the Impacts of Outsourcing by Gabrielle Baker considers the relationship between Te Tiriti o Waitangi and the health system, before questioning the current coalition government’s “Elective Boost” programme with its policy of outsourcing and privatisation and the potential impact for Māori health outcomes.
• Economics, Health and Wellbeing: Who’s on Board for the Paradigm Shift? by Marilyn Waring outlines the failure of traditional economic measures such as GDP and its inability to count unpaid work, health status and environmental wellbeing before detailing the new approach promulgated by the WHO Council on the Economics of Health for All.

The genesis for all these reports was ASMS’ publication in 2021 of Creating Solutions: A roadmap to health equity 2040, which made 13 recommendations to address growing health inequity in Aotearoa. If those recommendations are going to be implemented, it is going to require an increase in funding. Taken together, these papers lay the foundation for a robust public discussion about how we pay for the health system we need and want in this country.