New Zealand vs. Australia: comparing the medical systems

The calibre of a healthcare system plays a big part in determining the quality of life in a country. The quality of care reduces disease prevalence, extends life expectancy, and enriches personal wellbeing, culminating in a more vibrant, productive society.

New Zealand and Australia both offer world-class healthcare systems, renowned for their comprehensive services and patient-centric approaches. In a ranking of the top countries in the world for healthcare systems Australia was ranked twenty first and New Zealand twenty fifth in a list of one hundred and four.

Both countries provide universally accessible care, with a strong emphasis on public health initiatives and preventive medicine. New Zealand excels in community healthcare delivery, while Australia's system is highlighted by its advanced medical technology and research. These systems are backed by governmental support, ensuring a high standard of medical services that contribute to the overall wellbeing and longevity of their populations.

New Zealand and Australia face parallel challenges within their healthcare frameworks, aging populations, growing mental health issues, and rural healthcare deficits.

This article compares and contrasts the two countries, allowing future IMGs to make an educated decision about where they want to live, and where they can create a life they love.

A brief overview of New Zealand's medical system

In 1938, the New Zealand Labour Government passed the Social Security Act. They believed that every New Zealander had a right to a reasonable standard of living. Part of this act ensured that healthcare was brought under the social security programme, so that every resident of New Zealand could receive free healthcare.

In 1938, the New Zealand Labour Government passed the Social Security Act. They believed that every New Zealander had a right to a reasonable standard of living. Part of this act ensured that healthcare was brought under the social security programme, so that every resident of New Zealand could receive free healthcare.

In modern New Zealand, the intent remains that all Kiwis, Australians, and New Zealand permanent residents can receive free or subsided healthcare. This includes primary health care, specialists, surgical, and pharmaceuticals. In the 1980’s, private hospitals and providers began to cover some medical care and it resulted in the mixed scheme they have today.

The government created ACC, the Accident Compensation Corporation. This provides no-fault compensation to individuals who suffer from accidental injuries at work, home, or even overseas. ACC pays for medical care, compensation for loss of income, rehabilitation, and payouts for permanent disabilities.

The ambulance system is largely run by St John, a private not-for-profit organisation.

Prescriptions from GPs or public hospitals are subsidised by Pharmac and are free for all residents. Some prescriptions from specialists are partially funded or not subsidised, and this must be covered by the individual. Families with more than 20 prescriptions from specialists or dentists can apply for a subsidy card which reduces costs.

Te Whatu Ora runs the healthcare system. This is a single agency modelled after the British NHS. Alongside this, Te Aka Whai Ora was created to specifically manage the concern of Māori. Under the health authority, four regional divisions were established:

• Northern: Auckland and the far North
• Te Manawa Taki: Central North Island
• Central: From MidCentral of the North Island to Wellington
• Te Waipounamu: The South Island

There are several key principles underpinning New Zealand’s health system:

• Improving child wellbeing
• Health and disability system reform
• Improving wellbeing through preventative measures
• Improving mental health
• Providing better primary health care
• Creating a strong and equitable public health system
• Ensuring a financially sustainable health system

A brief overview of Australia's medical system

In 1973, the Australian Universal Health Care Bill failed to pass three times. Finally, after some political wrangling, the legislation was passed in 1974, ensuring free public healthcare for all Australians. In 1975, the bill was changed to limit the free healthcare to retired people. Then, in 1984, the current Medicare system was created.

Medicare covers public hospital care, some GP services, and some pharmaceuticals for New Zealand and Australian citizens and permanent residents. There is some variation across states and territories. The federal government covers funding via Medicare Benefits Scheme (MBS) and pharmaceutical Benefits Scheme (PBS). States and territories manage the delivery of services for public hospitals, dental care, ambulances, mental healthcare, and community health initiatives. Local governments deliver community and preventative health measures such as immunisations.

There are two safety nets over and above the free public healthcare and capped pharmaceutical costs for those with income-tested concession cards. The Original Medicare Safety Net (OMSN) covers the Medicare fee over a certain amount every year. The Extended Medicare Safety Net (EMSN) covers 80% of medical costs over a yearly threshold.

Because of this complex regional and national funding model, there’s a mix of public and private facilities. Funding rules aren’t always clear, with overlapping boundaries. It’s not uncommon to find private patients at public hospitals. It’s not a simple model.

The National Healthcare Agreement of the COAG (2012) says that Australia’s healthcare system must:

• Be formed around the needs of individuals, families, and communities
• Focus on the prevention of injury and disease rather than the treatment of illness
• Support an integrated approach to wellness
• Provide all Australians with timely and quality health care

Healthcare funding: New Zealand vs. Australia

In New Zealand, they spend:

• New Zealand spends on average, 8.86% of their GDP on healthcare, mostly funded from tax.
• The spend in 2020 was about US$4,202 per person
• ACC is funded from specific ACC levies charged to businesses, vehicle licensing charges, and a part of taxes paid on salaries. In 2022, it paid out NZ$4.9 billion
• New Zealand’s pharmaceutical sales are equivalent to $US222 per capita

In Australia, they spend:

• About 10% of their GDP on health, of which two thirds is funded by the federal government
• The spend is around US$5,901 per person
• Overall, Medicare is funded by a government levy. In 2016, it raised AU$114.6 billion
• A share of this levy goes towards the National Disability Insurance Scheme
• Australia’s pharmaceutical sales were equivalent to $US416 per capita

Patient care standards: a comparative insight

In Australia, the National Safety and Quality Health Service (NSQHS) Standards are there to provide consistent levels of care across all healthcare organisations. It has a broad array of standards that cover guidance for technical aspects and processes, and patient care and communication. The Hospital Patient Experience Question Set (AHPEQS) is designed to measure patient satisfaction. The results can be drilled down by state, provider, and services received. The 2022 report on government services found:

• 91.8% of people who accessed hospital care found that they were listened to by doctors and specialists
• For all measures, Aboriginal people reported lower scores

The New Zealand Ministry of Health has health care service standards which are administered by Standards New Zealand. These standards are designed to provide everyone with respectful, safe, and appropriate medical care in a way that is tailored to their needs. The patient survey is administered by the Health Quality and Safety Commission. It’s run every three months, where a selection of adults are invited to participate.

Access and coverage: who gets what?

Both New Zealand and Australia face similar challenges with access and coverage of healthcare. Both countries have geographically isolated areas which can be difficult to staff and service. Alongside this, their indigenous people, Māori and Aboriginal, experience poorer medical care than other ethnic groups, and this results in worse outcomes for their longevity and health in general. 55% of Australians have private healthcare insurance in some form, and this level of cover depends on their income. About 1.2 million (of 5.2 million Kiwis) have private health insurance. For both countries, low-income families are less likely to have medical insurance and are reliant on the public healthcare system.

Technological advancements and innovations

Australia is embracing digital transformation and innovation in healthcare. Use of:

• Better patient care using digital records and easier access to all patient records
• Diagnostic AI, with things like a ‘parascope’, which is a self-advancing endoscope, or software such as Harrison.ai, which uses AI to analyse imaging to detect disease and inconsistency in patients
• Bioprinting, which is 3D printing human organs and hearing aids
• Sensor technology in hospitals or aged care homes that identifies when residents have fallen, or are wandering around

New Zealand, known for their number-8-wire attitude, are similar in their creation in use of technology and innovation.

• Rex Bionics allows disabled and injured people to stand up and complete physical therapy exercises in a supported, safe, and accurate way
• ARANew Zealand has created a platform that offers wound surveillance and reporting using imagine and AI
• Techion New Zealand has created a digital microscope that allows remote parasite detection and identification of parasites, allowing for better antibiotic treatment
• 98% of New Zealand GP’s use software for patient management and prescription generation

Both countries are eager to use and develop technology, and both are acknowledged as early adopters of technology. The 2009 Commonwealth Fund survey ranked New Zealand first for advanced electronic health information capacity among primary care physicians.

Challenges faced by New Zealand and Australia

Both Australia and New Zealand grapple with health disparities affecting their indigenous populations. Aboriginal and Māori communities experience lower life expectancies due to systemic healthcare inequities—17 years less for Aboriginal Australians, and Māori dying seven years earlier than non-Māori. Concerted efforts are underway in both nations to rectify these conditions.

Both countries are facing staff shortages. With long waits for GPs, specialists, and surgery, has led to some healthcare professionals are facing burnout. With a drive to entice trained doctors and medical professionals from overseas, they hope to have more people moving. With an aging population, both countries are aware of the urgency to address this.

The impact of culture and demographics

Colonisation has created wide systematic inequalities that affect the indigenous Māori and Aboriginal people in New Zealand and Australia respectively. As part of IMG training, there is specific, targeted training that will help new healthcare workers to understand and respect the cultures they will be working with. These standards and practices vary for both countries and can be complex to address but must be approached with empathy and understanding.

Ease of transitioning for IMGs

Both New Zealand and Australia are actively recruiting medical graduates from overseas. Both countries have strong pathways that encourage international students to study in New Zealand and Australia, leading to permanent residency.

Australian pathways for IMGs

There are three pathways for medical graduates intending to practice in Australia:

Competent Authority Pathway: Once meeting requirements such as a primary qualification in medicine and surgery by a recognised institution, they must complete an assessment with a relevant authority. They must complete 12 months of supervised practice in a hospital or GP role. From there, IMGs can apply for general registration.

Standard Pathway: Once meeting requirements such as a primary qualification in medicine and surgery by a recognised institution, they will pass the AMC Computer Adaptive Test (CAT) MCQ examination or the AMC CAT MCQ Examination and the AMC Clinical Examination. After this, 12 months of supervised practice in an approved position.

Specialist Pathway: This is for IMGs who are qualified to practice in their field of speciality. Once completing an assessment through a relevant medical college, they will assess against Australian criteria. There is then a period of supervised practice before being granted recognition as a specialist.

International Medical Graduates working in New Zealand

There are several pathways for overseas trained doctors to come and work in New Zealand. The choice of pathways differs for junior and senior doctors, but all pathways take into account a combination of qualifications and experience. All pathways require overseas doctors to complete a period of supervised practice and some can require additional exams or training as advised by the Medical Council.

The key pathways we work with are:

Junior

Competent Authority: Doctors who have completed both their Medical Degree and Internship training in either the UK or Ireland are eligible for medical registration via this pathway. If a UK or Irish grad has completed an internship in another country, they can apply to the Medical Council for recognition of that internship for the potential to also be considered eligible for this pathway. To apply for this role, applicants will need to have a job offer from a New Zealand hospital and will need to complete six months of supervised practice.

Comparable Healthcare System pathway: The Medical Council have designated twenty-four healthcare systems as being comparable to those in New Zealand. If an applicant has worked thirty-three out of the last forty-eight months in a comparable healthcare system, they can be granted registration to work in the same area of medicine, at the same level. These candidates must work under supervision for twelve months.

Senior

Locum Tenens: If an applicant holds one of the approved qualifications and a job offer, they can be granted Special Purpose Locum Tenens registration for twelve months. They require supervision for the entire time.

Vocational: This is the complete assessment needed for a candidate to work in NZ as a specialist. If they hold an overseas postgraduate qualification, they can apply to have this and their subsequent experience assessed by the relevant medical college to determine how it compares to the local training. The outcome of this assessment determines their comparability and what they are required to do in order to gain full registration.

Comparing New Zealand and Australian medical systems

Healthcare funding model

New Zealand: Mixed. Free public healthcare for all paid for by tax collected by the government. This is supplemented with private healthcare for those who can afford it.

Australia: Mixed. Free public Medicare healthcare from the federal government, paid for by tax revenue. State and territory or local governments have overlapping responsibilities. There are some private healthcare facilities too, paid for by those who can afford it.

Patient care standards

New Zealand: Good standards with room for improvement

Australia: Good standards of patient care

Accessibility

New Zealand: Accessible but with systemic challenges for Māori

Australia: Accessible but with systemic challenges for Aboriginal people

Technological integration

New Zealand: High levels of technological integration

Australia: High levels of technological integration

Challenges

New Zealand: Staffing shortages, aging population, lack of long-range planning

Australia: Fragmented nature of funding model, staffing shortages, aging population

Unique features

New Zealand: Low spend per head, innovation and efforts to improve Māori access to healthcare, the no-fault ACC system, and wide-ranging pharmaceutical funding model

Australia: Run across all levels of government. Emphasis on disease prevention. Life expectancy very high, 6th in OECD

New Zealand and Australia are both great places to work and live

Due in part to their shared colonial history, geographical isolation, and desire to provide a quality free healthcare system for their entire population, New Zealand and Australia have a number of similarities in their system. Both offer quality care for their populations, with a focus on preventative medicine, community care, and accessibility for all citizens and residents.

Much like the cricket and rugby rivalry, Australia and New Zealand both want to offer the best care to their citizens. They are keen to adopt technology to improve their services, outperform other countries (and each other), and prepare for the future by enabling easier immigration for qualified healthcare professionals.

Want some more information?

We have a dedicated team of Solution Specialists who are experienced in helping overseas-trained doctors make the move, they will guide you through the visa application, registration requirements, and suggest the medical pathway that is best for you.

Register today and one of our team will give you all the information you need to know and set you up for a successful relocation.