Health NZ is chasing more than $70 million in unpaid bills from tourists and migrants who are not eligible for publicly funded care, and its chief financial officer, Bevan McKenzie, says 25 to 30 percent of outstanding debt is typically written off as unrecoverable each year. On this year’s figure, that is somewhere between $17.5m and $21m the taxpayer absorbs before the debt collectors have even finished dialling.
The trajectory matters more than the total. The same Health NZ figures show debt of $45.6m in 2022/23 and $18m across the then-20 DHBs in 2019/20. That is a 53% jump in three years and close to a fourfold rise in six. McKenzie suggested post-pandemic travel growth may explain some of it. Maybe. But a cost line that grows this fast and gets a fixed write-off rate is no longer an anomaly. It is a budgeted feature of the system.
A rule with no teeth where it counts
The design flaw is simple. Most visitors on visas of less than 12 months are not eligible for public healthcare, but full medical checks are usually only required for stays longer than that. Travel insurance is compulsory for some categories, such as international students and parent visas, but not standard visitor visas. So the people with the least screening carry the most open-ended exposure.
The cases show how it plays out. One man did not disclose a pre-existing renal diagnosis or two criminal convictions to Immigration New Zealand. Family payment arrangements were made in late 2023, yet by March 2025 he owed $174,746. INZ’s own notes said it was “still not satisfied” he met visa requirements, then granted a 12-month medical treatment visa anyway “as an exception to instructions” so life-preserving treatment could continue. Officials found seven people seeking urgent renal care soon after arriving on visitor visas in the year to December 2024. None declared adverse health information, at least two knowingly gave false information, and all were on treatment for end-stage renal failure within a month of landing.
Nobody sensible argues hospitals should turn away a dying patient. Immigration Minister Erica Stanford is right that clinical decisions should not hinge on ability to pay. But once treatment starts, the eligibility rule has effectively zero deterrent value, precisely in the chronic, high-cost cases where the dollars are largest. Concealment carries no meaningful penalty if the outcome is a visa exception.
Old warnings, same pattern
This is not news to officials. In 2018, government documents revealed one slide stating “we have had to ration dialysis”, with officials noting that when ineligible overseas patients arrived at a full unit, existing patients would get reduced treatment to fit everyone in. The Ministry of Health disputed that rationing was happening at the time, but the point stands. The cost is not only financial. Capacity spent on ineligible patients is capacity New Zealanders on dialysis do not get.
In 2020, the NZ Herald found foreigners received $204.4 million of hospital treatment over five years, with taxpayers covering roughly a third. Then-Health Minister Andrew Little called it “the cost of being a compassionate country”. Compassion is a fine principle. It is a poor accounting method.
Small number, strained system
In fairness, $70m is modest against Vote Health spending of $26.081 billion in 2024/25, about 0.27%. Back in 2019, Newsroom reported overseas patient debt made up only about 5 percent of outstanding debt at boards like Hutt Valley.
But Health NZ is not an organisation with slack. Treasury warned in 2024 that forecast surpluses masked significant overspend in hospital and specialist services. Every avoidable write-off competes with elective surgery lists, staffing and the capital programme. Businesses chasing a 25% bad debt rate on a growing receivable would be asked hard questions by their bank.
Fix the gate, not the migrants
This should not become an anti-immigration story, and business groups are right to push back if it does. BusinessNZ argued in 2025 that working-age migrants contribute more to the tax base and consume less public services. With population growth slowing to just 0.7% in 2025 and net migration supplying 45% of it, employers need the pipeline open.
The fix is narrow and cheap. Make health insurance mandatory for visitor visas, as many countries already do. Require sponsors of high-risk applicants to post bonds rather than offer promises that, as McKenzie conceded, they are not always able to meet. And make proven non-disclosure of a known serious condition count against future visas for the applicant and those who sponsor them.
None of that touches the skilled workers and students business relies on. It simply stops the most expensive leak in the system being treated as a cost of doing business. If Health NZ’s next figure lands above $70m, the government will have no excuse for not having closed the gap.
Sources
- RNZ: Health NZ chases $70m in unpaid health bills from tourists and migrants (2026-10-07)
- RNZ: ‘We have had to ration dialysis’ – Immigration NZ (2018-08-13)
- NZ Herald: Foreigners get $5.22m in treatment from Bay of Plenty hospitals, DHB writes off debts worth million (2020-11-14)
- Newsroom: Paying for migrant healthcare (2019-11-27)
- Treasury: Report T2024/913 Health New Zealand 2023/24 year-end position (2024-04-12)
- Ministry of Health: Annual Report for the year ended 30 June 2025 (2025-10-30)
- Ministry of Health: Health and Independence Report 2025 (2026-08)
- BusinessNZ: Immigration Fiscal Sustainability System Integrity Amendment Bill submission (2025-07-28)
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