Opinion writer Ian Powell argues that private health insurance is a symptom of a struggling public system, not its competitor.

As private health insurance grows in Aotearoa, New Zealand, many believe it threatens the country’s public health system. Former Association of Salaried Medical Specialists executive director Ian Powell disagrees. He says the rise in private insurance does not undermine public care but instead highlights the growing weakness of the public system itself.

Background

Powell’s perspective draws from both personal experience and decades of observation. He recalls how his parents avoided private insurance and instead saved money for potential medical needs. Their “pay-as-you-go” approach, he says, once made sense when public hospitals were well funded and efficient.

In the 1990s, he saw the first cracks appear when New Zealand’s health system was reshaped under market-style reforms. These changes, designed to increase competition between public and private hospitals, left public care underfunded and struggling to keep up.

Evolving Context

The landscape has changed dramatically since then. Over the past decade, Powell notes, the public health system has suffered from constant financial pressure and workforce shortages. This environment has pushed more people toward private health insurance simply because they cannot rely on timely public treatment.

He argues that the situation is not a reflection of private insurance success but rather of public sector decline. “Private insurance has shifted from being an option to a necessity for those who can afford it,” he explains. “That makes it a symptom of a broken system, not a cause.”

Financial Pressure on Insurers

Interestingly, private insurers are also struggling. The Financial Services Council recently reported that a third of people with private health cover have reduced or downgraded their policies. Rising premiums have made insurance unaffordable for many.

Southern Cross Health Society, New Zealand’s largest health insurer, recorded a $51.8 million deficit in the 2024–25 financial year after claims rose 16 percent. Common procedures such as hip and knee replacements were among the cost drivers.
Premiums are climbing by up to 20 percent per year when age-related increases are included. Despite this, membership has slightly declined, showing that more people are being priced out.

Broader Systemic Problems

Powell argues that the real problem lies in how successive governments have managed health funding. He points to years of austerity and poor planning that left hospitals short of staff and resources. “Continuous neglect of the workforce,” he says, “has created a cycle of underperformance and delay.”

He also contrasts the present crisis with the 1990s. Back then, there were fewer workforce shortages, more hospital beds for elective surgery, and lower emergency demand. Today, the system faces rising acute care needs while struggling to maintain planned treatment schedules.

A Revised View

Powell’s latest analysis is blunt: the true threat to private insurers is the collapse of public hospital capacity. As public hospitals fall behind, more people seek private care, which drives up claims and forces insurers to raise premiums. That spiral hurts both patients and insurers.

In his words, “Private health insurance is not a rival to the public health system. It is evidence of the public system’s decline.”

Conclusion

Ian Powell’s commentary offers a sobering reflection on the state of healthcare in New Zealand. The growing reliance on private health insurance, he says, is not a sign of progress but a warning sign that public hospitals are no longer meeting people’s needs. Until governments fix long-term funding and workforce issues, both public and private healthcare sectors will remain under strain.

Photo: Webfit News / Health System Report 2025