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Criteria changed for publicly-funded healthcare

Ministry announces changes to eligibility criteria for publicly-funded healthcare

The Ministry of Health says that the Eligibility Direction has been reviewed.

The Eligibility Direction sets out eligibility criteria for publicly funded personal health and disability services in New Zealand. Only people who meet the criteria defined in the Eligibility Direction can receive publicly funded (ie free or subsidised) personal health and disability services.

Dr Colin Feek, Deputy Director General of Clinical Services, says it was timely to review the current criteria given the growth of international students to New Zealand, and to assess whether the criteria was still appropriate.

Eligibility settings are largely based on rights of citizenship, humanitarian/international obligations, and recognition of the contribution to New Zealand made by residents and long term (two years or more) work permit holders.

Key changes to be implemented from October 30, are:

- Changing the eligibility settings for New Zealand citizens so that they are eligible, regardless of how long they are in New Zealand - increasing the age, from under 16 years to under 18 years, that a dependant child may be deemed eligible via an eligible parent/legal guardian - removing eligibility for student permit holders and visitor permit holders.

"The most significant change, in terms of numbers of people affected, is the removal of eligibility for foreign fee paying (FFP) students," says Dr Feek.

"Of the 82,000 FFP students in New Zealand last year, it's estimated that about 20,000 are currently eligible for publicly funded health services. I don't consider the Government has an obligation to provide this second group of permit holders public funded health services, as they generally don't intend to remain here on a permanent basis. Also, removing eligibility for FFP students it will eventually free-up some of the funding for eligible people."

The new Eligibility Direction will not be applied retrospectively to individuals who are currently in New Zealand and who are eligible at the time the new Direction comes into force. Visitors and students who are granted consecutive permits and visas to re-enter New Zealand will retain eligibility.

The compulsory medical and travel insurance provisions will apply to all international students enrolled or enrolling from 1 January 2004, no matter how long they have been or intend to be in New Zealand. Many education providers already require international students to hold health insurance for the period of time they are studying in New Zealand.

The review identified differing eligibility criteria for different categories of citizens, significant growth in the number of FFP students, the need to make the Eligibility Direction easier for health providers to use and assess patients' eligibility.

The amendments won't affect overseas visitors' eligibility for cover for personal injury under the Injury Prevention, Rehabilitation, and Compensation Act 2001. The acute health services provided by DHBs to ACC are available to everyone in New Zealand. Australian residents and UK nationals will retain eligibility for treatment that is required urgently and cannot be postponed.

Copies of the revised Code are available on the Ministry of Education?s website, at www.minedu.govt.nz/goto/international.

Questions and Answers:

What are changes, and why? The following table sets out the main amendments to the Eligibility Direction:

Table One Category Current Eligibility Criteria Amended Eligibility Criteria Rationale for change Citizen New Zealand citizen and has lived or intends to live in New Zealand for two years or more. New Zealand citizens from Cook Islands, Niue or Tokelau are deemed eligible when in New Zealand. Is a New Zealand citizen (including those whose usual place of abode is in the Cook Islands, Niue or Tokelau). Right of citizenship. All citizens given equal access to publicly funded services. Reflect current practice and administratively simpler. Student permit holders

Eligible if: · has a permit or consecutive permits that equal(s) or exceed(s) two years or · has a permit of 12 months or more and can demonstrate a reasonable expectation of having a further permit issued for a period that allows that person to remain in New Zealand continuously for a period that equals or exceeds two years. Remove eligibility for student permit holders. Government does not have an obligation to provide publicly funded health services to FFP students.

Make explicit that eligibility is retained for Commonwealth Scholarship holders and NZAID Scholarship holders. Maintain humanitarian and reciprocal obligations. Visitor permit holders Eligible if has a permit or consecutive permits that equal(s) or exceed(s) two years. Remove eligibility for visitor permit holders. Government does not have an obligation to provide publicly funded health services to this group. Dependant child of eligible person Eligible if under 16 years and in care and control of an eligible parent/legal guardian Eligible if under 18 years Dependant children of long term (two years or more) work permit holders will be defined by NZIS policy (16 years of age or younger, or 17 to 19 years of age where dependency can be shown). and in care and control of an eligible parent/legal guardian Aligns with UN definition of child. Recognises that most children of this age are still dependant on a parent/guardian.

What is the Eligibility Direction? The Eligibility Direction sets out the eligibility criteria for publicly funded personal health and disability services in New Zealand. Only people who meet the criteria defined in the Eligibility Direction can receive publicly funded (ie free or subsidised) personal health and disability services. Other than dependant children of some eligible people, individuals are required to be eligible in their own right. The latest Eligibility Direction was issued in July 2000.

Why was the Eligibility Direction reviewed? The Ministry of Health identified a need to review the Eligibility Direction earlier this year. The initial aims of the review included: · Making the Eligibility Direction easier for providers to operationalise. · Reviewing eligibility for foreign fee paying students. · Updating the language of the Eligibility Direction.

The review provided an opportunity to consider the rationale for each eligibility criterion and to assess whether the current settings are still appropriate. The eligibility settings are largely based on rights of citizenship, humanitarian/international obligations, and recognition of the contribution made by long term work permit holders and residents who have an intention to live and work in New Zealand on a long-term or permanent basis.

What are the main changes to the Eligibility Direction as a result of the review?

The main changes to the Eligibility Direction as a result of the review are:

· All New Zealand citizens will be deemed eligible for publicly funded health services whenever they are in New Zealand · Eligibility for student permit holders (both foreign fee-paying and domestic) will be removed regardless of length of stay in New Zealand · Eligibility for people on visitor permits will be removed regardless of length of stay in New Zealand. The Government?s recent decisions about eligibility for publicly funded maternity services for overseas-resident women will be reflected in the updated Eligibility Direction.

The most significant change in terms of numbers of people affected is the removal of eligibility for international students. Of the 82,000 international students in New Zealand in 2002, it is estimated that approximately 20,000 are currently eligible for publicly funded health services. The other amendments to the Eligibility Direction are expected to affect limited groups of people only.

Changes to the Code of Practice for the Pastoral Care of International Students Recent changes to the Code of Practice for the Pastoral Care of International Students (the Code) require all international students to have compulsory medical and travel insurance. Section 7.4 of the revised Code requires signatories to the Code to ensure that International students have appropriate and current medical and travel insurance for the duration of their planned period of study.

A transition period applies to revisions to the Code, which allows the Code Administrator to temporarily suspend any requirements of the Code to 1 January 2004. The compulsory medical and travel insurance provisions will apply to all international students enrolled or enrolling from 1 January 2004, no matter how long they have been or intend to be in New Zealand. Many education providers already require international students to hold health insurance for the period of time they are studying in New Zealand.

Copies of the revised Code are available on the Ministry of Education?s website, at www.minedu.govt.nz/goto/international.

When will the new Eligibility Direction come into force? The Minister of Health is authorised to issue Directions to District Health Boards under section 32 of the New Zealand Public Health and Disability Services Act 2000. The new Eligibility Direction will be gazetted on 2 October 2003 and implemented 28 days later on 30 October.

The new Eligibility Direction will apply from the day it is implemented to all individuals who are not eligible. This means that students and visitors who are not currently eligible and who are granted visas to enter or extend their stay in New Zealand after the new Eligibility Direction is implemented in October will not be eligible for health services regardless of their length of stay in New Zealand.

However, the new Eligibility Direction will not be applied retrospectively to individuals who are currently in New Zealand and who are eligible at the time the new Direction comes into force. Visitors and students who are granted consecutive permits and visas to re-enter New Zealand will retain eligibility.

Changes to the Eligibility Direction will not affect overseas visitors cover for ACC

The amendments to the Eligibility Direction do not affect overseas visitors? eligibility for cover for personal injury under the Injury Prevention, Rehabilitation, and Compensation Act 2001. The acute health services provided by DHBs to ACC claimants are available to everyone in New Zealand (including all foreign visitors and student permit holders) irrespective of their length of stay, visa status, or nationality.

Changes to the Eligibility Direction will not affect the Reciprocal Health Agreements with Australia and the UK The Reciprocal Health Agreements with Australia and the United Kingdom (UK) are also not affected by the amendments. Australian residents and citizens and UK nationals will retain eligibility for treatment in New Zealand?s public health system (hospitals and medicines) for the treatment that is required urgently and cannot be postponed.

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