Patient eligibility for publicly funded healthcare
This case note concerns an investigation under the Ombudsmen Act 1975, resulting from a complaint to the Ombudsman about the failure of a district health board (DHB) to identify that a patient was ineligible to receive publicly funded health care before elective surgery in 2014. The patient’s lawful immigration status had inadvertently lapsed following an overseas trip in 2012. As a consequence, the patient was not eligible for publicly funded health and disability services, under the Health and Disability Eligibility Direction 2011 (issued under section 32 of the New Zealand Public Health and Disability Act 2000).
Under a DHB information sharing agreement, Immigration New Zealand (INZ) provides information on request about a patient’s immigration status to enable DHBs to verify eligibility for publicly funded services. The patient’s eligibility was confirmed by the DHB in January 2010 but was not re-checked before his 2014 surgery. The patient was shocked to receive an invoice for approximately $100,000. The DHB took the position that it was the patient’s responsibility to inform the DHB of any changes to his immigration status. The patient complained that the DHB should have informed him that he was not eligible for public funding prior to his second surgery. This would have prompted him to regularise his immigration status before the further surgery.
The DHB reconsidered its position when notified of the Ombudsman’s investigation and decided to write off the amount owed for treatment, even though it maintained the patient had contributed to what occurred. The DHB advised that it did not have the necessary infrastructure to perform ongoing checks of a patient’s eligibility once that status had been confirmed, but undertook to review its systems to mitigate against further such cases. In these circumstances, the Ombudsman discontinued his investigation.
This case note is published under the authority of the Ombudsmen Rules 1989. It sets out an Ombudsman’s view on the facts of a particular case. It should not be taken as establishing any legal precedent that would bind an Ombudsman in future.