Around one-third of colonoscopies are privately funded as Health NZ struggles with staffing shortages.
By Farah Hancock of RNZ
As the public health system struggles with colonoscopy waitlist targets, more Kiwis are forking out thousands for the procedure privately.
Malcolm Mulholland usually advocates for other people struggling with the public health system. Today the tables are turned and the chair of Patient Voice Aotearoa is now fighting for himself.
A colonoscopy last year discovered polyps which had a high chance of becoming cancerous.
They were removed, but the diagnosis put him in the high-risk category for bowel cancer, meaning he should now have an annual surveillance colonoscopy.
Instead, in December last year he received a letter from Health NZ saying surveillance colonoscopies were being paused because of short staffing in the MidCentral health district, where he lives. If he lived elsewhere in the country, he would receive one.
He was told he would receive an update in June, but Mulholland says he has heard nothing.
Mulholland says he had two options: wait in the public pool alongside 20,000 others or pay out of pocket. In the end, he decided the risk was too high and booked privately for $3000.
“We’re all led to believe that we receive universal public health from the cradle to the grave, and nothing can be further from the truth at the moment,” he says.
He knows he is lucky to afford it, but is adamant no one should need to pay.
“Colonoscopies are vitally important, they’re a tool that basically ensures that you live if caught early enough, but if not, and sadly, that will be the case for some of those people who can’t afford it, they will die as a result.”
Bowel cancer is New Zealand’s second-highest cause of cancer death, responsible for about 1200 deaths a year. Colonoscopies are one way to catch the disease early.
Mulholland is just one of many people deciding to self-fund the procedure. Data shows around a third of all colonoscopies in New Zealand are now paid for privately.
New Zealand’s public health service, Health NZ, has increasingly turned to outsourcing to tackle the backlog. Data shows a spike in publicly funded colonoscopies for 2023, with 67,500 completed. Approximately 30% of these were outsourced to private providers.
Officials describe outsourcing as a “long-term tool, not a stop-gap measure” – where low complexity cases can be completed by private providers.
“It enables Health New Zealand to make use of all capacity and reduce wait lists faster, sooner,” says Health NZ director of planning for hospitals Rachel Haggerty.
That surge in 2023 briefly stopped the rate of growth in the waiting list. But when there was a dip in delivery in 2024, the backlog ballooned.
As of May 20,450 people were waiting for colonoscopies, with almost 60% waiting longer than the recommended wait time, Health NZ data showed.
The targets say 90% of urgent colonoscopies should be seen within two weeks, and 70% of non-urgent patients within six weeks.
For surveillance procedures, the time extends out to 70% of cases by 12 weeks.
Data for May shows only 82% of urgent colonoscopies were meeting the targets. The odds are much worse for everyone else. Fewer than half of non-urgent and surveillance colonoscopies were being done within the recommended wait times.
One Auckland patient’s letter – seen by RNZ – said half the people with a priority 2 rating needing a non-urgent colonoscopy were seen within 13 weeks, with most being seen within 53 weeks.
Haggarty said Health NZ continued to work hard to reduce wait times, and the size of the waitlist had fallen since the start of 2025.
By contrast, RNZ found private clinics in Auckland could offer an appointment within two weeks. Quoted prices ranged from $2400 to a top price of $6500, depending on sedation and whether polyps were found and removed.
New Zealand Private Surgical Hospitals Association chief executive Chris Roberts attributes the rise in private colonoscopies to three things: increased awareness of bowel cancer, an ageing population, and the introduction of the bowel screening programme for 60-to 74-year-olds.
Many of the people who receive colonoscopies privately have health insurance, numbers from Southern Cross show clients received more than 32,000 colonoscopies in the 2025 financial year, but self-funded procedures were growing, Roberts says.
“The motivations for that will be varied, but it does appear that some people see how long it will be for them on a waiting list and decide to go ahead and pay for it themselves.”
Private providers were responding by investing in more facilities and staff to perform the procedure, he says.
The main reason for the long waitlists is a shortage of gastroenterologists.
A 2017 study found some centres had no gastroenterologists at all. These included Tairāwhiti, Wairarapa, West Coast and Whanganui. Taranaki, South Canterbury and Northland had a single gastroenterologist.
In 2017 there were 93 gastroenterologists, now he says there are 110. Malcolm Arnold, who co-authored the research, estimates the public workforce is about half what it needs to be to cope with the demand for colonoscopies.
“Virtually every unit in the country has vacancies for gastroenterologists and for all the surgeons.
“Hawke’s Bay has two [gastroenterologists], and should have four. Rotorua I think they have one and they should have three.”
He puts the problem down to pay. New Zealand is not matching the conditions gastroenterologists can enjoy abroad.
“Australia is always knocking on our back doorstep, so we can make two or three times as much money if we worked in Australia.”
Short-staffing creates a self-perpetuating problem, he says.
“The trouble is, if you’ve got two doctors working somewhere that should be four or five or six, who’s going to apply to be number three?”
Haggerty says there are currently at least nine vacant roles for gastroenterologists, not counting Canterbury, West Coast or Tairāwhiti.
The agency is actively recruiting, and also holding extra clinics on weekends and using locums to try to meet demand.
MidCentral, where Mulholland lives, is one region using locums.
MidCentral gastroenterologist Dr James Irwin said its unit was currently recruiting after two of its four doctors stopped performing colonoscopies for health reasons.
Irwin said his team had done an audit, and paused surveillance procedures after discovering those patients were at the lowest risk of developing cancer.
When the pause on surveillance colonoscopies made the news, hospital management overruled the decision, and recommenced surveillance colonoscopies for a small number of people on the waitlist. Irwin said that came at the cost of delays to urgent cases – and that was the kind of trade-off hospitals faced daily.
“Most other departments sort of shuffle the deck chairs on the Titanic,” he says. “We were attempting to maintain timely symptomatic colonoscopy to the detriment of surveillance colonoscopy.”
Haggerty told RNZ that surveillance colonoscopies were recommenced in MidCentral in February. Since then 95 people have been seen, 187 people have been advised of an appointment date and 80 patients received colonoscopies privately.
She sympathises with the 852 patients who were notified of the pause.
For patients, the delays aren’t about politics and numbers. They’re scary, and stressful.
“You’re thinking about: How is my life going to change? Will I lose my house… Do I have cancer or not?” says Bowel Cancer New Zealand chief executive Peter Huskinson.
He says the system’s vague letters – saying things like “most patients will be seen within 53 weeks” – add to the anxiety.
“Most is such an elastic term. Does most mean 51% or does most mean 99%? Who knows?”
Huskinson wants wait times, particularly for those last on the list, to be clear. He wants the screening age lowered to match Australia, where it is 45, rather than New Zealand’s soon-to-be 58.
And he wants a push to hit colonoscopy targets.
Huskinson has a background in health economics, and thinks any additional cost of $3500 per colonoscopy to catch cancer early makes more sense than the $85,000 to treat someone with bowel cancer.
Reaching the six-week target for 95% of patients should be achievable, he says.
“That shouldn’t be a pipe dream. That’s the basic standard of care that you’d find in some other countries.”
- RNZ