Table 1 The New Zealand Health System

New Zealand’s 1938 Social Security Act was the world’s first attempt to create a “national health service”, but doctor resistance meant this was never achieved. A series of policy compromises mean that, today, public hospitals salary all staff and are free of patient charges. General Practitioners mostly practice privately and act as gatekeepers. They receive considerable government subsidies but charge most patients a fee per consultation, creating an access barrier [37]. There is a strong tradition of family practice and focus on primary care within the health system. Yet, the arrangements set down in the post-1938 compromise mean GPs and public hospitals work largely separately from one another. Government contributes around 80% of total health expenditure. Around 40% of public hospital specialists have a separate private practice. The parallel private system means patients of better means are able to circumvent public hospital waiting times when referred by their GP, or to access treatments considered to be lower priority in the constrained public sector [49].