Humanity, not money, should be the priority when it comes to hospital care for visitors to New Zealand, says a Tauranga iwi leader.
Foreigners have had more than $204.4 million worth of hospital treatment in New Zealand in the past five years, and taxpayers have had to foot the bill for about a third of that between July 2015 and June 2020, excluding GST.
That's according to data provided by all bar one of New Zealand's 20 district health boards.
In the Bay of Plenty District Health Board area, non-residents got just over $5.22m of care, and the board wrote off around a fifth - about $1.19m - as bad debt.
The largest single bill written off was worth $116,342.
Non-residents are not eligible for publicly funded care in New Zealand but hospitals will provide emergency or urgent care and bill the patient afterwards. Injuries caused by accidents are paid for by ACC regardless.
Paora Stanley, chief executive of Tauranga Moana iwi Ngāi Te Rangi, said years ago he fell badly ill in Canada before his health coverage had kicked in.
Fearing he would not be able to get treatment and medication, he sent his Canadian wife to the doctor with his pneumonia-like symptoms.
"I could have died there because I could not get access to meds."
The experience backed his view that humanity should be the first principle in making services accessible to people in need.
"Is it okay that people come into this country and get sick and become a burden on the system? As a human, yes, it's okay. Let's stick to first principles: look after people and don't care where they come from."
Kiwis were happy to take tourists' money, so when they needed help we should give it and "sort the rest of it out later", Stanley said.
He queried how many Kiwis travelled overseas without medical insurance, but would still expect treatment if they needed it.
In his view, the amount of debt written off was "not a lot" in the context of New Zealand's health budget of more than $20 billion for 2020/21 alone.
The iwi has run a free mobile clinic for 12 years, and Stanley said he had seen clients walk away after learning Immigration might be able to access its records, and that worried him.
"What would happen if that person had TB or Covid?"
But Whanau Ora commissioning chairwoman Merepeka Raukawa-Tait, also a Rotorua district councillor and Lakes health board member, said she believed non-residents should be "prepared to pay for any health services they receive".
"I believe the Ministry of Health should develop and put in place nationwide guidelines for DHBs to ensure medical procedure costs are made known to non-residential visitors seeking care. Payment to be agreed to, before medical care is provided.
"No DHB can afford to write off bad debt. New Zealand should stop being a soft touch."
Health Minister Andrew Little said the debt was "the cost of being a compassionate country" and a "relatively modest one at that".
"We've all seen stories about the plight of New Zealanders who fall ill in countries that have less compassionate health services than us. I'd like to think we're better than that."
Little said New Zealanders shouldn't worry that the cost would affect health services available to them because there was a process for the Ministry of Health to compensate DHBs for treatment costs they had to write off.
"Nevertheless my expectation is that DHBs pursue every reasonable opportunity to recover money owed to them following treatment of ineligible patients," he said.
All health boards said letters and phone calls, local and international, were used to follow up unpaid invoices but outstanding payments were eventually referred to debt collectors and written-off as bad debt.
A Ministry of Health spokesman said it was important anyone needing emergency care could get it which inevitably led to bad debt as some patients could not afford to pay and others could not be traced.
Regarding the rising cost of treatment, he said costs incurred by DHBs were increasing independent of patient numbers, but it was also likely the number of ineligible patients seeking treatment was going up.
The spokesman said Government advice was that travellers obtain comprehensive travel insurance if they are not eligible for publicly funded health and disability services.
"In most cases, DHBs only provide services to ineligible people (those not covered by the eligibility direction) where they present acutely or in an emergency situation.
"DHBs are expected to use their best endeavours to recover the costs of treatment for ineligible people."
The Bay of Plenty District Health Board was also contacted for comment.
"Too lenient" - immigration advisor's view
Some commentators have said to reduce the debt the Government should look at making visitors prove they have full health insurance.
Other suggestions included not allowing people in poor health to visit, refusing a visa to anyone with an outstanding debt and forging no-charge reciprocal healthcare agreements with other countries.
Navdeep Kaur, licenced immigration advisor and co-owner of Bay-based Genuine Immigration, said she believed New Zealand's policies in this area were "too lenient".
"I strongly agree there should be requirements imposed to have appropriate insurance cover for all travellers as it is the case in many other countries, such as Australia."
This would reduce pressure on the health system and the taxpayer's burden, she said.
"Even a healthy person can fall sick anytime."
But, in her view, it would be unfair and inhumane to stop people with poor health travelling to New Zealand to see loved ones or for leisure.
She said more should be done to hold to account people who sponsored a relative or friend's visa and agreed to look after the entrant's welfare.
"In reality when an unfortunate situation arises, they will just back off and not pay the medical bills, which contribute to unpaid debts."
In her experience, many travellers did not get medical insurance because of the cost or perceived hassle of getting a payout. New Zealand insurance companies tended to be more responsive but few provided insurance to visitors, she said.
"We have seen situations where visitor visa holders were hospitalised and had heavy medical bills but luckily they had insurance cover by a New Zealand insurance company so it was paid off.
"On the other hand, we have clients who just ignore it. When they need medical care they create financial pressure on their families and end up in bad debt and then they accuse our healthcare system of not looking after visitors, which is completely not correct."