Opinion: New Zealanders deserve a public health system that is there when they need it. Yet too many face long waits, struggle to access a GP, cannot afford care or watch their health deteriorate while waiting for treatment.
These are not inevitable features of a modern health system. They are consequences of political choices about funding, workforce planning, public ownership and whose needs count.
As the next election approaches, Kaitiaki Hauora | Together for Public Health has surveyed political parties on their plans for our public health system. The responses reveal a fundamental problem: keeping the system standing still is not the same as meeting people’s needs; it would leave the system in its current crisis-level state.
Neither National or Labour funding plans ‘are enough’
Our analysis of National and Labour’s health funding plans for 2028 to 2031 found that neither funds enough for cost pressures and the aging population in order to “stand still”, and Labour considerably less because they provide no additional funding for 2031; we understand this because Treasury provided figures for only the first three years.
Doubtless they will provide such funding should they become Government, given they did so in previous terms in office, but how much is unknown.
National’s provision for 2031 is clearly inadequate, being no increase over 2030.
Both show additional operational funding for items they have prioritised. Labour funds considerably more than National, averaging $615 million per year compared to National’s $196 million, or $2.5 billion and $0.8 billion respectively over the four years.
In total, they say they will fund almost identical amounts over the four years – Labour $15.5 billion and National $15.4 billion. This is only enough to “stand still” according to our estimates, based on Ministry of Health cost data. Any additional services will pile on new pressures.
However, if, as we expect, Labour funds the fourth year of cost pressures and demographics at or above National’s inadequate provision, it would be clearly ahead, but still far short of the step change that is desperately needed.
Labour proposes more investment in primary care and prevention, averaging around $615 million annually. National proposes approximately $196 million annually for additional medicines funding and lowering the bowel screening age to 50.
However, our estimates based on international benchmarks suggest an additional $1.3 billion annually is needed for primary care and $973 million for population health.
A wild card is that Labour is promising to spend an unquantified amount on restoring pay equity, likely to be several billion dollars. A big part of that is almost certain to go to Health, assisting in recruitment and retention of staff as well as moving towards equity.
Capital investment is another major concern. Te Waihanga, the Infrastructure Commission, recommended hospital investment that amounts to approximately $8.7 billion over four years. Labour identifies $200 million for hospitals, while National identifies $111.5 million for specific projects.
Our hospitals cannot deliver the care people need without adequate infrastructure and capacity.
ACT, National and New Zealand First did not respond to our survey. However, their published policies provide context: ACT supports long-term contracts with private providers for elective surgery, an expensive way of providing procedures which could be delivered within a properly funded public system and does not specify any funding to “stand still”, while New Zealand First has promoted prevention without offering comprehensive funding commitments.
Green Party, Te Pāti Māori and Opportunity Party indicate support across priority areas
ACT, National and New Zealand First did not respond to our survey. However, their published policies provide context: ACT supports long-term contracts with private providers for elective surgery, an expensive way of providing procedures which could be delivered within a properly funded public system and does not specify any funding to “stand still”, while New Zealand First has promoted prevention without offering comprehensive funding commitments.
By contrast, the Green Party, Te Pāti Māori and the Opportunity Party indicated full support across the survey’s priority areas: universal access to healthcare, significant funding boosts (for the Greens, shown in their recent fiscal plan), immediate workforce expansion, and ending further privatisation.
They also back secure, long-term funding and decision-making authority for Iwi-Māori Partnership Boards.
Labour has also made commitments on workforce planning, Māori health and ending further privatisation, though its funding proposals raise questions about delivery.
National-led coalition inferior to a Labour-led government
In our MMP system, the commitments of smaller parties matter. Given these minor party policies and the current coalition’s record over its first term, which has created a crisis situation in our Health System, a continuation of the current National-led coalition is clearly inferior to a Labour-led government.
Kaitiaki Hauora calls for three core commitments
Kaitiaki Hauora is calling for three core commitments from every political party seeking to govern: properly fund public healthcare through major boosts in the next and subsequent Budgets; honour te Tiriti through long-term investment in Iwi-Māori Partnership Boards; and keep healthcare public with universal access and an end to further privatisation.
We need a legislated commitment to universal access to healthcare, an end to privatisation, and independent long-term planning to guide funding, workforce and infrastructure needs.
Equity, tino rangatiratanga and Te Tiriti o Waitangi
For Māori, this debate is also about equity, tino rangatiratanga and our obligations under Te Tiriti o Waitangi. Iwi-Māori Partnership Boards were established under the Pae Ora (Healthy Futures) Act to give communities a meaningful role in identifying health needs and influencing services. They need secure funding and genuine decision-making authority to strengthen Māori-led solutions, devolved decision-making and ensure local knowledge and Māori aspirations inform priorities and investment.
The question facing voters is which parties will fund the services people need, address entrenched inequities and build the public capacity our health system requires.
A health system funded only to stand still will continue to fall behind. New Zealanders deserve better than a permanent crisis. They deserve a public health system that prevents illness, provides timely treatment and cares for people with dignity.
Dr Bill Rosenberg and Louisa Wall are Executive Members of Kaitiaki Hauora | Together for Public Health, which advocates for well-funded, equitable public healthcare.
