New immigrants to Auckland unfamiliar with the health system are turning up to hospitals when they should be going to doctors, MPs on the health committee heard yesterday.
And the fast changes to the population of Auckland, a third of which was Asian, meant there were no longer winter peaks.
"We've just got a surge the whole year," Lester Levy, chairman of the Auckland District Health Board, told MPs.
It also meant the board was looking at expanding the space given to the emergency department.
Chief executive Ailsa Claire said the board was doing a lot of work with overseas students and new immigrants to get them to understand how the New Zealand health system worked and to get them to enrol with a primary health care provider or with student health services at the universities.
"For some of the new immigrants coming through and also for a lot of our student population, they are not used to a health system where they've got a primary care element to it. So instead of enrolling with student health ... or enrolling with a general practice they will tend to come to the hospital for what we could call basic healthcare services."
That meant they missed out on health screening programmes or were difficult to engage on immunisation targets.
Dr Levy said a third of the Auckland population was now Asian.
It had happened "incredibly quickly" and was having an impact.
"We don't have a winter peak any more in Auckland DHB. We've just got a surge the whole year and that is of serious concern to us because you used to deal with this and then there'd be a bit of opportunity for renewal, because we worry about our staff, and away we'd go again.
But that's gone. It's sustained."
Chief financial officer Rosalie Percival said the Auckland DHB was complex because it provided services for the rest of the country, such as paediatrics, cardiac surgery and heart and lung transplants, and for other DHBs, as well as its own area.
"So our challenge is how do we have a pricing mechanism that is fair to everyone around the inter-district flows and enables us to be sustainable without the Auckland population supporting the rest of the country effectively by subsiding that.
"There is always a tension there and that is a real challenge to us."
Percival said the board's indicative funding for the 2016/17 year was based on population statistics from October last year and the board stood to get $60 million more on population increase, but it would also lose $20 million because a reduction in deprivation was factored into the population funding as well.
The challenge would be around what the board was paid for the work it did for other boards.
Women smash through glass ceiling
Women have smashed through the glass ceiling at the Auckland District Health Board, according to chairman Lester Levy.
Appearing before MPs on the health select committee yesterday, he was flanked by three executives, all women, and he said that in the senior management team - 12 in all on the ADHB website - only two were men.
"For those of you who read about the glass ceiling and the fact that women find it difficult to get top jobs, I can let you know that in the rest of our executive team, women occupy the role of the director of human resources, the chief information officer, the head of nursing and allied health and we have a few mere males in two roles," he said.
Auckland DHB was one of the biggest employers in the country.
"It just goes to show that there is every opportunity and other organisations should look at our organisation to show what can be done."