Senior health executives are globe-trotting to exotic destinations on taxpayer money, spending millions of dollars on travel, food, meetings and hotels in three years.
The expenses, released exclusively to the Weekend Herald under the Official Information Act, have been labelled "extravagant" and "indulgent".
A nurses' union is calling for the Ministry of Health to rein in the spending, saying DHB executives should be leading by example.
Cities and countries visited in the name of health included New York, Washington, Minneapolis, Honolulu, Rome, Milan, Geneva, Switzerland, London, Shanghai, France, Canada, Australia and more.
The figures show almost $3 million was spent on flights, food and accommodation between July 2014 and June last year by 207 executives across the country's 20 district health boards.
It comes after the Herald revealed in December DHB chief executives racked up an additional $1.2 million during the same three financial years.
In real terms, $4.2m could pay most of the running costs of a hospital ward for a year, buy much-needed lifesaving equipment, or pay for 123 heart bypass operations.
At the time Health Minister David Clark said he wanted evidence the spending was worthwhile, and a former DHB chief executive called international travel an unnecessary luxury.
Now the New Zealand Nurses Organisation has called for measures to prevent "precious health dollars being squandered" on non-core health services.
"It is concerning, particularly the amount spent on international travel costs," industrial adviser for DHBs Lesley Harry said.
"It does appear on the face of it to be indulgent and we would expect that executive DHB staff lead by example."
The Weekend Herald's special investigation into spending within DHBs also revealed last month that chief executives, their senior executive teams and board members, about 444 people, cost the country around $66 million a year in salaries.
The newest figures show Counties Manukau District Health Board's leadership team, between 10 and 12 people, spent the most since July 2014, at $550,694.
The highest average spend per executive at the DHB was $18,304 in one year, and collectively they spent $201,000 in the 2015/16 financial year alone.
Counties Manukau acting chief executive Gloria Johnson said expenses at the DHB were more closely scrutinised since mid-last year, now requiring CEO sign-off for all international travel including transtasman, and as a result were markedly lower for the first half of this financial year, at $22,993.
The extra scrutiny coincided with the launch of an investigation by Waikato District Health Board into its then chief executive Dr Nigel Murray, who was found to have breached travel policies when he spent $218,000 of taxpayer money in three years.
It also followed changes to Counties Manukau's executive leadership team including the departure of chief executive Geraint Martin and four executives, whose jobs were then rolled into one position.
Johnson said the costs of domestic travel increased from 2014 because three executives were national chairs or in senior DHB leadership positions and needed to travel to Wellington regularly.
She defended international travel, saying it enabled executives to visit and observe programmes in similar health systems.
"Our approval process for overseas travel includes ensuring that a trip relates to current health service initiatives or requirements, and/or provides professional development opportunities, including visiting hospital and clinical facilities and interacting with other health service providers."
Only one other DHB, Hawke's Bay, spent more than $10,000 per executive each year, with an average spend of $11,394. Other DHB executives spent between $2000 and $7000 each year.
Expenses for all DHBs included domestic and international flights, meals, accommodation, conference registration, professional association and membership fees, practising certificates for executives who were also health professionals, mileage, relocation costs and equipment.
Of the 20 DHBs surveyed, Canterbury and West Coast refused the OIA request but provided the results of an expenses audit conducted after Murray's spending came to light.
Nelson Marlborough DHB did not supply expenses despite a two-week extension.
Harry said the spending was out of balance with the expectations on nurses and midwives to "do more with less".
"At a time when our members are expected to work under enormous pressure that's arisen primarily as a result of cost-cutting, of course we're very concerned that precious health dollars may be squandered on matters that actually don't necessarily benefit the health consumer and the workforce that provide the services."
She called for "sound oversight" on spending, particularly for international travel.
"It seems like there has become a culture of indulgence in this sector and with a new Minister of Health, it's a good time to look at the systems to make sure that extravagance is not tolerated."
A spokeswoman for the Minister's office said it was up to district health boards to ensure they shared relevant information from training events and conferences.
Craig Climo, a former DHB chief executive for 17 years, said there was a culture of expectation among public health executives.
He said anyone who travelled for work on the public purse should have a genuine need to and not "just be swanning around".