Pitched as a patient-first revolution for a system in crisis, ACT's health platform bets that competition, private contracting, and stripped-back bureaucracy can do what decades of public spending has not.

The Policy: ACT Health Policy — October 2023 →

What it does

• Government as purchaser, not provider. ACT's central proposition is that Health New Zealand should contract with private hospitals and diagnostic providers for elective procedures, specialist appointments, and imaging — rather than building public capacity to meet demand.
• Reduce waiting lists via private contracts. Health NZ was directed by the coalition government to issue five-year contracts with private hospitals for elective surgery, with contracts of up to ten years thereafter. The government target — 95% of patients treated within four months — was established as a measurable, trackable commitment, something ACT secured in the Government Policy Statement on Health.
• Abolish the Māori Health Authority. Te Aka Whai Ora was formally disestablished by 30 June 2024, a flagship ACT priority. ACT argued the Authority embedded ethnicity-based care prioritisation; ACT health spokesperson Todd Stephenson said it would "bring the health system closer to ACT's ideal of services delivered based on New Zealanders' needs, not racial identity."
• Pharmac reform. ACT unveiled a medicines policy requiring Medsafe to approve drugs within one week where two comparable regulators (Australia, US, UK) had already done so. ACT noted New Zealand launched only 16% of 460 new medicines approved globally between 2012–2021, compared to 34% for Australia. David Seymour was appointed Associate Minister of Health (Pharmac) in the coalition.
• Primary care expansion via pharmacists. ACT proposed extending pharmacist scope to cover chest infections, ear infections, long-term medication management, and skin lesion triage — reducing pressure on GPs. This builds on pharmacist services already expanded under the coalition (UTIs, scabies, emergency contraception).
• Mental health innovation fund. ACT proposed a standalone Mental Health and Addiction NZ agency and a $20 million fund for community providers that demonstrate measurable outcomes. The coalition agreement funded Mike King's Gumboot Friday $6 million per year, with Budget 2024 allocating $24 million over four years.
• Performance transparency. ACT secured measurable health targets published by Health NZ, including emergency department wait times, elective surgery waits, cancer treatment timeliness, and immunisation rates — with public reporting obligations.
• Credential recognition for overseas health workers. ACT proposed streamlined pathways for qualified immigrant doctors and nurses from comparable health systems, particularly to fill rural primary care gaps.

The result

New Zealand's public health system entered the 2023 election in serious distress. As of February 2025, over 74,000 patients were waiting longer than four months for a first specialist assessment — up from 51,000 in June 2023. More than 36,000 patients waited beyond four months for treatment. Orthopaedics, ENT and general surgery bore the heaviest backlogs. Only about 60% of patients were being treated within the four-month target, against a goal of 95% by 2030.

Health New Zealand's financial position compounded the crisis. The agency posted a $722 million deficit for the year ending June 2024, extending a cost-reduction programme to 2027. The hospital and specialist services division alone ran a projected $1.4 billion deficit in 2024–25, driven by underfunding relative to demand, workforce shortages, and COVID-era deferrals.

Supporters of ACT's approach argue the status quo is unsustainable. Fiona Michel of Braemar Private Surgical Hospital notes that private hospitals already perform nearly 70% of elective surgeries — about 224,000 annually. Health NZ Deputy Chief Executive Robyn Shearer describes public-private partnerships as "a pragmatic way to meet the government's wait time targets" when the public system cannot meet demand alone.

Critics dispute the diagnosis and the remedy. Professor Robin Gauld (Bond University, formerly Otago) warns that private providers poach clinical staff without increasing system-wide capacity: "Where there is increased access to private sector delivery there is actually less access to public sector." A 2021 Otago University study found 2% of privately treated patients required a public hospital admission within seven days of private treatment, costing $11.5 million in cost-shifting to the public system.

Six University of Auckland and Otago health researchers argued in August 2024 that underfunding — not structural inefficiency — is the primary driver: New Zealand spent US$3,929 per capita on health in 2020 against Canada's US$6,215 and Australia's US$5,802, and has not submitted health expenditure data to the OECD since 2018. The NZ Medical Journal editorial argues the mixed public-private model risks "privatisation by stealth, design or default," with equity falling hardest on Māori, Pacific peoples, and low-income New Zealanders.

Green Party co-leader Chlöe Swarbrick called on the government to "be absolutely clear" on whether it intends to privatise public services. The Public Service Association argued Health NZ's infrastructure plan was "ushering in privatisation." Labour's position is that Pharmac should receive more direct funding, with their 2023 election policy promising $1 billion in additional Pharmac funding over four years.

On the Māori Health Authority abolition, multiple health professionals argued the disestablishment would adversely affect Māori health outcomes given persistent and documented gaps in life expectancy and access to care. Legal action was attempted in December 2023 to halt the disestablishment.

The impacts to watch

• Equity of access as private contracts scale. The NZ Medical Journal documents that private insurance uptake is significantly lower among low-income groups — those who cannot afford private care are concentrated in an increasingly strained public residual system. More than one in three New Zealanders reported being unable to access a GP in 2022/23.
• Specialist workforce leakage from public hospitals. If private contracts draw surgeons and anaesthetists away from public facilities, training pipelines and complex-case capacity in public hospitals could erode — a risk the NZ Herald noted the private sector itself acknowledged.
• Pharmac access and the "whole of society" costing question. Seymour's push for a whole-of-society costing model for Pharmac — counting economic productivity lost to illness — could unlock more drug funding, but critics warn it risks prioritising commercially valuable patients over those with the greatest clinical need.
• Rural and Māori health outcomes post-MHA. The disbanded Māori Health Authority had specific accountability for closing persistent health gaps for Māori. Whether Health NZ's unified structure can sustain those accountability mechanisms is an open, trackable question.
• Mental health outcomes from community funding model. The Gumboot Friday/$24 million experiment channels funds through a charity rather than the clinical system. The Spinoff documented the "bleak reality" for mental health workers outside this funding stream, raising questions about whether innovation funding complements or substitutes for systemic resourcing.
• Whether 95% elective surgery target is achievable by 2030. At the current trajectory — 60% meeting the four-month target as of late 2024 — closing the gap will require either a significant surge in contracted surgical volume or a material reduction in demand, neither of which is straightforwardly achievable within Health NZ's constrained fiscal envelope.

Our suggestion: draw the line by patient outcome, not ideology

ACT's instinct that the public system cannot grow its way out of the waiting list crisis with existing structures has some support in the evidence — private hospitals do deliver high volumes of elective procedures efficiently. But the evidence equally warns that contracting-out without careful safeguards can deepen inequity, poach clinical staff, and shift costs rather than reduce them. The productive middle ground is a contractual framework that protects public training obligations, prevents cost-dumping, monitors equity outcomes by ethnicity and income, and preserves GP funding as the first line of care. The test is not whether care is delivered in a public or private building — it is whether the patient who needed a hip replacement in 2023 has it by 2026, regardless of their postcode or pay packet.