The country's 20 health board bosses have spent $1.2 million of taxpayer money on travel, training and meetings in three years, prompting concern the spending needs to be reined in.
Minister of Health David Clark last night said he wanted evidence the spending was worthwhile, while a former DHB chief executive described international travel as an unnecessary luxury.
The Weekend Herald investigation of expense claims prompted renewed calls to cut the number of DHBs in half, and follows a freeze on training for nurses earlier this year at one DHB with their union calling for strict controls on CEO travel.
The expense spending is on top of six-figure salaries DHB chiefs earn annually, and in many cases more than what the average Kiwi earns each year.
In real terms $1.2 million can pay for 400 cataract surgeries, 59 hip replacements, or 35 heart bypasses.
Destinations visited in the name of health include Paris, London, New York, Amsterdam, Florida, Canada, Ireland, Scotland, Singapore, China and all over Australia.
During the three years DHB chief executives collectively spent $629,804 on domestic travel, $372,859 on international travel and $224,516 on "other" expenses such as conference registration, membership fees including to Air NZ's Koru Club, training, relocation, hospitality and home internet plans.
Clark said chief executives were public servants with an accountability to taxpayers, and to people who rely on the health system.
"Since becoming Minister of Health, I've met with all DHB chairs and CEs, and have outlined my high expectations of leadership by example in the health sector.
"One of the things I would like to see is evidence that lessons learned at conferences, both nationally and internationally, are shared widely across the sector.
"When an average of $20,000 per DHB CE is being spent annually, the public rightly expects that the investment they make in our health services is used wisely."
The biggest spender was former Waikato District Health Board chief executive Dr Nigel Murray, who resigned in October after spending $218,166 between July 2014 and June 2017.
That case is now being investigated by the State Services Commission.
Canterbury and West Coast DHB chief executive David Meates attended an international directors programme in France four times in less than two years, totalling $50,889.
Board chairman Dr John Wood said he and Meates agreed the CEO should attend the programme because it was "challenging and beneficial", and the board had an expectation of ongoing professional development.
The former CEO of Counties Manukau DHB, Geraint Martin, spent $16,762 on a 33-day "US sabbatical", and Dr Nick Chamberlain spent $119,487 as CEO of Northland DHB.
He pointed out his travel from Whangarei to Wellington once a week as lead chief executive for two national portfolios was costly because of his regional location.
The DHB said $12,161 of the expenses were for Chamberlain's registration as a doctor.
He was not the only CEO to use taxpayer money to pay for annual practising certificates, or for membership to Chartered Accountants.
Tairawhiti DHB chief Jim Green made no international travel but each Christmas he spent about $2000 throwing a party for staff and their families at the Gisborne Pools.
Less than three days into the job at MidCentral DHB in May 2015, Kathryn Cook took a $1240 trip to Auckland for a conference and dinner, and six weeks later she flew to New York at a cost of $8461 for a study tour.
Cook's travel request showed detailed justification of the tour that included ACC, and the DHB supported the travel.
Bay of Plenty DHB chief Helen Mason claimed $13,399 for attending the Institute for Healthcare Improvement [IHI] Conference in Florida last year and $6602 on registration to attend the Exponential Medicine Conference in November 2018.
The DHB chair Sally Webb defended Mason's travel listing specific benefits from the IHI conference, and said it was an essential part of a DHB CEO's role.
New Zealand Nurses Organisation industrial adviser for DHBs Lesley Harry said spending needed to be scrutinised at a time of added pressure to health budgets; including a training freeze on nurses at Hawkes Bay DHB until July this year.
"This should be strictly prioritised on the basis of improving DHB health services for the community and improving working relationships with staff."
She called for accountability and reporting of expenses through DHB boards and monitoring by the SSC to ensure transparency and good use of public money.
Former DHB chief executive for 17 years, Craig Climo, said he had no time for international travel and that a conversation around value for money was needed.
"I just don't think it's necessary. You can do a heck of a lot of learning in this day and age with modern technology without stepping far from the office.
"The vast majority of New Zealanders don't have the opportunity to undertake paid business travel and we all need to be sympathetic of that."