Northland District Health Board has been forced to write off more than $250,000 in unpaid medical bills incurred by patients not eligible for publicly-funded healthcare.
In addition to that, the Accident Compensation Corporation (ACC) has paid out $350,054 in claims lodged by overseas tourists for various injuries in the four years between 2014 and 2017.
While the government picks up the bill for Kiwis, and those from countries with reciprocal medical agreements such as Australia, overseas tourists without medical insurance have to repay the cost of their treatment.
In the last financial year alone, the Northland DHB wrote off $49,322 owed by nine overseas visitors who received acute care such as surgery.
In 2017, $52,890 was written off, $39,442 in 2016, $74,387 in 2015 and $40,623 the year before.
"Only a small number of people not eligible for publicly funded healthcare do not settle their debt. We also have people who are paying off their debt by instalment," Northland
DHB's general manager finance, funding and commercial services Meng Cheong said.
He said it would not refuse care to acutely unwell patients.
"Northland DHB has a clear strategy with regard to the recovery of overseas patient debt including the use of overseas debt collectors, this has been the case for many years."
Cheong said most of the patients first presented at the emergency department and, if they were not admitted, were expected to pay at the time.
He said if any of the demographic data indicated the patient was not a New Zealand citizen, further documentation was requested to determine eligibility.
Cheong said debts were not written off until all collection options have been exhausted.
"When a debt is written off the patient details are lodged with Immigration NZ, on the odd
occasion Immigration NZ have been in contact where they have stopped a patient, but this
has not resulted in the recovery of any debt."
The ACC figures exclude the cost of emergency treatment at public hospitals, which is bulk-funded under Public Health Acute Services.
ACC paid out $97,270 in 2014, $35,771 in 2015, $90,301 the following year and $126,712 last year.
Spokesman James Funnell said tourists and visitors made a significant contribution to the New Zealand economy.
"They also contribute to the cost of ACC in a number of ways. For example, people who hire a rental car pay a levy on petrol purchases, and car rental prices include the cost of vehicle registration, which incorporates an ACC levy.
"In addition, overseas visitors who work in New Zealand pay an earners' levy, as well as paying income tax."
He said because ACC was a no-fault scheme that removed the right to sue for personal injury suffered in New Zealand, all overseas visitors who injured themselves were eligible for cover for their treatment and rehabilitation.
Northland tourism leader Jeroen Jongejans said only a small number of overseas tourists ended up with unpaid medical bills that were not huge amounts of money considering their contribution to New Zealand's economy.
"GST tourists pay amounts to billions of dollars each year and that money goes to general funds and helps pay for medical services. When one looks at big scheme of things, the amount owed is significant for Northland but it's not crippling," he said.