Immigration

Who should pay for migrant healthcare?

A review of the rules around the entitlements of migrants to public healthcare is a question of when, not if, Dileepa Fonseka reports.

Rules around what migrants and visitors pay for when it comes to healthcare are due for a shake-up when a Government review gets off the ground. 

Immigration New Zealand officials signalled the likelihood of the review in a briefing to the Minister of Immigration in August 2018: “A review...is being contemplated by the Ministry of Health, however there is no timeframe for the review at this time.”

Currently, the Minister of Health’s “Eligibility Direction” from 2011 means any person who holds a “residence class visa” is eligible for publicly funded healthcare - including rest home care. 

Phil Knipe, chief legal advisor for the Ministry of Health, said five years had passed since the direction came into force which meant a review was automatically due under the Crown Entities Act. 

The briefing to the Immigration Minister notes that parents sponsored by migrants hold “residence class” visas so they and their children don’t owe DHBs any money for the healthcare services they use.

A spokesperson for Iain Lees-Galloway said the review wasn’t underway yet.

“As noted in the paper, MBIE will work with the Ministry of Health to consider the findings of any review when it is undertaken.”

The note came in the context of discussion documents regarding the rules around the sponsoring of parents by migrants to New Zealand. 

“Under current policy, a sponsored parent, as a resident, is eligible for publicly funded health care including aged care support if eligible," the spokesperson said.

If a patient isn’t eligible for publicly funded healthcare the cost of their care is recorded as a debt against their names. 

A health board says it can take a long time to recoup healthcare debts from migrants. Photo: Lynn Grieveson

Recovering the debt

When a 27-year-old American woman on a work visa started coughing up blood after giving birth to her child doctors told her she should stay in hospital a little longer.

She decided not to, she had already racked up an $8000 in debts to a District Health Board and following their advice would just see more costs mount up.

Five months later she was working in New Zealand and paying back her debt to the DHB at $10 per week according to an Immigration Protection Tribunal (IPT) ruling in 2018 that did not identify the health board in question.

“It can be a long recovery time for these debts especially if they do not have a New Zealand sponsor.”

Cases like hers - of unpaid debts by overseas patients - make up only 5 percent of total outstanding debts at DHBs like Hutt Valley DHB. 

A spokesperson for the DHB said it was “moderately successful” at recovering those debts. 

“It can be a long recovery time for these debts especially if they do not have a New Zealand sponsor.”

“When you get people with tuberculosis and hepatitis they’re not going to give a damn about somebody’s immigration status because there’s a whole public health aspect at stake here.”

Immigration lawyer Alastair McClymont noted that in recent years DHBs had been more “flexible” in their demands for payment - largely for public health reasons:

“I’ve never come across a single migrant whose been turned away from a hospital for something that’s even slightly urgent.”

“When you get people with tuberculosis and hepatitis they’re not going to give a damn about somebody’s immigration status because there’s a whole public health aspect at stake here.”

Lees-Galloway was briefed that there could be "operational challenges" with changing the eligibility rules - for examples the sponsored parents of migrants.

"In particular, it would be necessary for the Ministry of Health and healthcare providers (such as District Health Boards) to be able to identify individuals who are sponsored parent migrants from the information provided to them from Immigration NZ."

"MBIE will work with the Ministry of Health to identify solutions when a review gets underway."

There are "operational challenges" with changing eligibility rules MBIE officials say. Photo: Lynn Grieveson

Operational challenges

The need to improve the link between Immigration New Zealand and District Health Boards was dealt with by the Ombudsman in 2015. 

A patient at an unnamed DHB was eligible for free healthcare in 2010, but that eligibility changed when their immigration status changed four years later before their second operation. 

Within that time the government had changed its immigration laws, putting certain conditions on international travel that the patient had unwittingly broken when they had left the country on a school trip.

The hospital had checked their immigration status the first time but not the second. 

“The cases we’ve come across where INZ have found about it seems to have been that somebody has been proactive in a DHB and advised INZ when they’ve been aware of something.”

After the second surgery, the hospital billed the patient for $100,000 - an amount “neither he nor his parents could afford”. 

The DHB maintained it was the patient’s responsibility to check on their immigration status but the Ombudsman said they were “reluctant to conclude that informing DHBs of changes to eligibility was entirely the patient’s responsibility”. 

“The DHB was asked to give further consideration to whether the information sharing agreement with INZ could be expanded or whether its internal processes could be enhanced to avoid providing elective surgery to a non-eligible patient.”

McClymont said in his experience healthcare liabilities migrants were still reported by DHBs rather than by INZ. 

The Ombudsman flagged systems issues between the DHBs and Immigration NZ in 2015. Photo: Lynn Grieveson.

“The cases we’ve come across where INZ have found about it seems to have been that somebody has been proactive in a DHB and advised INZ when they’ve been aware of something.”

A spokesperson for Hutt Valley DHB outlined the processes in place for determining eligibility: 

Patients are asked for their residency status when they arrive at the hospital, those details are then forward on to the DHB’s “revenue team” who receive daily reports of the numbers of overseas patients.

“If there are any questions around the type of visa or length of stay in relation to eligibility, our team contact Immigration NZ to confirm the status and eligibility of the patient.”

The IPT has also displayed a degree of flexibility, sometimes granting 12-month extensions of visas that keep people eligible to pay for their own healthcare but also allow them to stay in the country to receive it. 

It also keeps the option of ejecting them at the end of that period open if the burden becomes too great. 

But after a rash of cases of Tongans visiting New Zealand on one-month visas then seeking dialysis - the treatment isn’t available in Tonga - IPT member Virginia Shaw noted the potential for increased costs within the system if lines weren’t drawn:

“The number of Tongans desperate to enter New Zealand so as to obtain dialysis is not going to diminish while Tonga is unable to afford to provide such treatment.”

Get it early – This article was first published on Newsroom Pro and included in Bernard Hickey’s ‘8 Things’ morning email of the latest in-depth business and political analysis. Get it early by subscribing now or starting a 28-day free trial.

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