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Government closes loophole for non-resident births

September 4, 2003

Media Statement

Government closes loophole for non-resident NZ births

Health Minister Annette King says the Government has decided to close a loophole, which developed after changes in mid-1999 gave non-NZ residents access to free health care to give birth in New Zealand.

“In future, ineligible women from overseas will be required to pay for antenatal, postnatal, and delivery costs of their health care,” said Ms King.

“When the changes were made in 1999, it was claimed they were to get rid of bad debts, and they were also seen as an advantage to the child, who would become a New Zealand citizen.

“District Health Boards recently raised with me concerns about this issue. Subsequently, I asked the Ministry of Health and DHBs to look at the available evidence. The information shows that there had been an increase in the number of non-resident women from overseas giving birth in New Zealand.

“Early this week the Ministry provided me with a breakdown of data of non-resident women who have given birth in New Zealand from 1999 to 2003. They were unable, however, to provide me with details of how many of these women were eligible and how many were ineligible.

“It is clear that many more non-resident women have been giving birth in New Zealand, and recent changes to data collection systems, that came into effect on July 1, will mean that in future it will be able to break this group down into eligibility status.

“The Government has decided to act quickly and close the loophole. Women in this position will now be required to pay for their healthcare. But children born in New Zealand will still be entitled to continuation of free care.”

Questions and Answers

What is the eligibility status of babies born to overseas residents?

New Zealand-born children of overseas-resident parents are New Zealand citizens by right of birth under the Citizenship Act. Under the Eligibility

Direction, which sets out who is eligible for publicly-funded health services in New Zealand, these children are eligible.

What is meant by "ineligible"?

The Eligibility Direction sets out who is eligible for publicly funded personal health and disability services in New Zealand. To be eligible for publicly funded health care you must be lawfully in New Zealand at the time of seeking services and meet one of the Eligibility Direction’s specified criteria. Most people are eligible because they are 'ordinarily resident' in New Zealand, that is, they live in New Zealand on a permanent or long-term (more than two years) basis. The Eligibility Direction is updated periodically. The Eligibility Direction has recently been reviewed and will be updated in October 2003.

Eligible overseas residents comprise:

- New Zealand citizens who live overseas but who choose to return to New Zealand to give birth.

- Long-term work permit holders who do not have New Zealand residence but who are nonetheless eligible for publicly-funded health services.

Ineligible overseas residents comprise:

- overseas partners and spouses of New Zealanders who are in the country on short-term immigration permits (many will have lodged or intend to lodge a residence application but do not yet have residence).

- overseas women in the country on short-term (less than two year) immigration permits or who have entered visa-free who are primarily in New Zealand for work or to visit.

- overseas women who enter New Zealand visa-free or on short-term permits whose primary purpose for entering the country is to have a baby in New Zealand.

How many ineligible women are accessing free health care to give birth in New Zealand?

It's not known how many ineligible women come to New Zealand to give birth, as the Ministry of Health's data previously did not collect that

information. However, from 1 July 2003, the Ministry began collecting data that distinguishes between eligible from ineligible women who give birth in

this country. There are no statistics yet available for July and August 2003.

What does the Ministry's data show?

The provisional figures for 2002/03 show 1,657 coded as "non-resident" women gave birth in New Zealand in 2002/03.

In 2001/02 there were 1,356; in 2000/01 - 1,116; and in 1999/2000 - 974.

However, the Ministry of Health believes the data may be an over-estimation of the numbers of ineligible women, given that some of the overseas-resident women will be New Zealanders. For example in 2002/03, 60 women identified as either Maori or Pakeha New Zealanders resident overseas.

These numbers include eligible women coded as overseas residents and non-eligible women coded as overseas residents. There is no way of distinguishing

these women from those who choose to give birth here solely to obtain New Zealand citizenship for their child.

How do these numbers compare with the overall number of births in New Zealand annually?

In 2002/03, there were 53,805 births in total in New Zealand. The 1,657 births to non-resident women is 2.9% of the total number.

Where are the women from? What kind of visas do they have?

The Ministry of Health's data only records the ethnicity of the women. We do not know country of birth, nationality or visa status.

(see attached table for a breakdown of ethnicity of non-resident women giving birth in NZ)

Why isn't there more detailed data about where the women are from, and which women are coming here just to give birth?

The data hasn't been collected in the past, because until the change announced today, the women were eligible for free health care in New Zealand. In the future, there will be more detailed information, because since 1 July 2003, the Ministry began collecting data that distinguishes between eligible from ineligible women who give birth in this country.

What was the situation before this change being announced today?

A policy statement issued by the Health Funding Authority in 1999 stated that women who are not eligible for publicly funded care have to pay for their ante natal care while in New Zealand. However, the District Health Boards bore the costs associated with the actual birth, and any health care costs for the child, because the child becomes a New Zealand citizen and is therefore regarded as eligible. Subsequent health care for the mother following the birth had to be paid for by the mother.

Are District Health Boards funded for the babies born to ineligible mothers?

Yes, the baby who is eligible for publicly-funded health services becomes part of the DHB’s resident population. The birth enters into the Statistics NZ base population and the DHB is funded under the population-based funding formula. DHBs should be charging women for any services that are solely for the benefit of the woman.

But how can DHBs recoup the costs if the mother leaves the country without paying?

Hospitals are used to dealing with health care for people who are ineligible, and should have processes in place to bill them for the health services they access.

Overseas mothers by ethnicity: 1999/00-2002/03


Ethnic Category Ethnic Group 1999/2000 2000/2001 2001/2002 2002/2003

Asian Asian not further defined 24 38 55 65

South East Asian 22 31 36 56

Chinese 79 80 107 149

Indian 64 82 125 223

Other Asian 81 96 153 220

Asian Total 270 327 476 713

Mäori 21 16 16 10

Other European not further defined 26 49 59 52

NZ European/Pakeha 54 42 46 50

Other European 81 127 211 273

Middle Eastern 12 16 38 54

Latin American/Hispanic 3 1 4 9

African 8 13 21 28

Other 71 64 33 42

Not stated 31 38 33 39

Other Total 286 350 445 547

Pacific Pacific Island not further defined 8 10 19 14

Samoan 195 206 198 195

Cook Island Mäori 9 11 6 4

Tongan 142 131 100 61

Niuean 4 2 3 2

Tokelauan 3 2 3 3

Fijian 22 38 43 46

Other Pacific 14 23 47 62

Pacific Total 397 423 419 387

Grand Total 974 1116 1356 1657

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