The chief executive of Waikato District Health Board received up to $130,000 more remuneration this year than he did 12 months earlier.
Dr Nigel Murray's remuneration increased from between $440,000 and $450,000 to between $560,000 and $570,000, according to the DHB's 2015/16 annual report.
DHB spokeswoman Lydia Aydon said the six-figure increase was not a pay rise, rather a mix of performance pay, cashed-out annual leave and KiwiSaver contributions.
Aydon said what the report did not show was that Murray, who joined Waikato DHB in July 2014, had not worked a full year when his remuneration was reported in June 2015, even though he was only short a few weeks.
She attributed "two-thirds" of the increase to performance pay and cashed-out annual leave and the rest KiwiSaver.
When asked how much annual leave Murray was entitled to cash in after less than two years in the job she said the DHB was not required by the States Services Commission to provide that level of detail.
Murray also received a 2 per cent increase in September this year, as per the State Services Commission guidelines.
When asked how the chief executive justified a sizeable performance pay at the same time the DHB was struggling with meeting some health targets, Aydon said as with all DHBs, performance was based on a range of measures agreed between the chief executive and the board.
Board chairman Bob Simcock said Murray's total annual remuneration rose by 2 per cent in 2015/16 as permitted by the commission but another factor why it appeared to increase by more was that performance-related income from one year was not paid until the next.
According to the most recent Ministry of Health data the DHB had the second worst performing Emergency Department in the country for meeting health targets, and it was the worst-equal performing for patients waiting for a first specialist appointment and treatment.
Aydon said overall the DHB performed well in many categories.
The Herald could not compare Murray's remuneration to other DHB chiefs for this year because the figures had not been released by the States Services Commission yet.
Of the main centre DHBs only Canterbury supplied the CEO's remuneration for the 2015/16 year, which was between $580,000 and $590,000.
It went up $10,000 from last year, and the Canterbury DHB chief was also responsible for West Coast DHB.
Of the 2014/15 figures, Auckland DHB chief executive was paid the most, between $640,000 and $650,000, which included a $60,000 increase on the year before.
The lowest was South Canterbury, between $270,000 and $280,000, a drop of $20,000 from the year prior.
Seven of the 20 DHB chief executives received remuneration of $500,000 or more in the 2014/15 year.
Labour MP Sue Moroney said Murray's increased remuneration was "outrageous given the stress that I know the staff are under at that DHB and the penny-pinching that is going on every day because of the lack of funding in the health sector".
"Which ever way you look at it the taxpayer is paying $100,000 more for the CEO than we were a year ago."
She said it was "fundamentally wrong" because doctors and nurses were under pressure and working overtime so that patients could have access to urgent and necessary healthcare while the chief executive was "basically getting a 25 per cent increase" in remuneration.
Unionised nurses received a 2 per cent pay rise this year and last year.