Tourists and migrants have run up bills of more than $70 million in unpaid public healthcare.
Health New Zealand says it's likely at least a quarter of that debt will not be recoverable, as it writes a similar amount off each year.
In one case a man had a $174,000 debt to Health NZ which he incurred after not disclosing his pre-existing renal diagnosis to Immigration New Zealand (INZ), nor two criminal convictions in his visa application.
Most visitors with visas lasting less than 12 months are not eligible for public healthcare. While all applicants must have an acceptable standard of health to be issued a visa, medical checks are usually only carried out on prospective migrants staying longer than that.
All others are urged to get travel insurance, but it is only a prerequisite for certain visas, including international students, some working holidaymakers and parent visas.
Health NZ chief financial officer Bevan McKenzie said the latest unpaid debt figure was higher than 2022/23's costs of $45.6m, possibly because of travel growth since the pandemic. It's also a large increase on the $18m of bad debt incurred by ineligible patients at the country's 20 then-DHBs in the year 2019 to 2020. Counties Manukau topped that list of affected areas, followed by Auckland, Southern and Waitematā DHBs.
"The amount written off varies from year to year; however, our experience is that between 25 and 30 percent of outstanding debts will typically be written off as unrecoverable," said McKenzie. "Health NZ uses a range of recovery actions, including invoices and reminders, payment arrangements, engagement with sponsors or insurers, and referral to debt collection agencies.
"Where sponsorship arrangements exist, Health NZ may seek assistance from the sponsor in meeting the debt. However, sponsors are not always financially able to meet these obligations. Clinical decisions are not based on financial circumstances and care is provided irrespective of a patient's eligibility or immediate ability to pay."
Health NZ used an external debt collection agency with international reach to support recovery efforts, he said.
"[Cost] recovery can be affected by overseas residency, patients leaving New Zealand, incomplete contact information, personal financial difficulty, limited insurance cover, and cross-border enforcement constraints." ·
Immigration minister Erica Stanford stays informed about some of the more expensive cases, which include the $85,000 costs of medically evacuating a Korean overstayer who had a stroke. The cost of her healthcare was not disclosed, but her treatment included two surgeries and lengthy rehabilitation.
Criminal cases
In a case brought to Stanford's attention, a man did not disclose his diabetes or end-stage renal disease to INZ.
When it found out, INZ granted him a 12-month visa as an exception to instructions. It had found out he had two undeclared criminal convictions, although the details were withheld in information supplied to RNZ.
Payment arrangements with the hospital were made by family members in late 2023 but by March 2025 the total amount due was $174,746. His GP confirmed he had ongoing treatment for terminal renal failure and had also since received palliative surgery after being diagnosed with advanced gastric cancer.
"INZ is still not satisfied that the applicants meet the instruction for the grant of a visitor visa under medical treatment category. However, INZ intends to grant the applicants the visitor visa under medical treatment category for 12 months as an exception to instructions to allow the principal applicant to remain in New Zealand for life preserving treatment," said officials at the time.
A Tongan man with four previous undisclosed convictions was also granted a 12-month visa to continue dialysis for end-stage renal failure.
The 57-year-old national could not receive the required dialysis treatment in Tonga, and was on haemodialysis treatments three times a week at Manukau Super Clinic.
"This treatment is a permanent and life-sustaining treatment. The applicant's medical treatment is not funded by his home government and treatment costs are not covered under New Zealand's Official Development Assistance programme. The applicant has provided evidence of a payment agreement for the debt outstanding between the applicant and Health New Zealand."
Another man needed kidney dialysis for the rest of his life, treatment was not available in his home country.
The 53-year-old arrived in New Zealand in June 2024 on a visitor visa, subsequently becoming unwell and being admitted to hospital. INZ approved his visa and that of family, who were supporting him during his treatment.
Dialysis costs
Clinical decisions are not based on someone's ability to pay.
Officials identified seven cases of people seeking urgent care for dialysis and/or renal failure soon after arriving on visitor visas in the year to December 2024.
"These individuals did not declare any adverse health information in their visitor visa applications and INZ does not require medical certificates to be provided for stays of less than 12 months.
"Looking closer at these cases, it has been noted that at least two of the individuals were confirmed to have been aware of their health issues prior to arriving and had provided false information to INZ in their application. Others were formally diagnosed after arrival in New Zealand. All individuals were receiving treatment for end stage renal failure within a month of arriving in New Zealand."
They all applied for medical treatment visas to remain in New Zealand to continue receiving renal care.
New Zealand has reciprocal agreements with the UK and Australia to provide limited, free healthcare to each other's citizens, and some treatment is also provided to certain Pacific citizens depending on their circumstances.
To be granted a medical treatment visa, for example for renal dialysis, they must be funded by either their home government or through New Zealand's Official Development Assistance Programme under the Medical Treatment Scheme, administered by the Ministry of Foreign Affairs and Trade.
"There are no renal care services available in [redacted country/region] and none of the seven individuals identified were receiving funding via these mechanisms for their treatment in New Zealand," said officials' notes to Stanford.
"Summary of this review will be shared with Ministry of Health and Ministry of Foreign Affairs and Trade, along with internal INZ Pacific teams."
Ministers have been warned specifically about renal care costs for several years. INZ told its appeal tribunal in 2018 that demand pressure from patients ineligible for New Zealand healthcare was leading to rationing of New Zealanders' dialysis treatment. At the time National Renal Advisory Board said patients were not at risk of reduced care.
More recently, kidney patients in Christchurch were also being warned dialysis treatment may have to be rationed because of staffing shortages and a lack of hospital space.
Health NZ's figures do not include the costs of treatment for migrants or visitors who have an accident, as that is paid for by ACC regardless of visa status.
