Data release

The public system funds less surgery per person than in 2018, and buys the difference from private hospitals

Source: NZPSHA, Elective Surgery 2018-2025

Health NZ funded 28.7 planned operations for every 1,000 New Zealanders in FY2025, down from 30.4 in FY2018. Public hospitals did 10,250 fewer operations than seven years ago, and one in five publicly funded operations now happens in a private theatre.

By Henry Smith · Health system · 2026-01-06

What this means for you One in five publicly funded operations now happens in the same private theatres that insurers and ACC book, so insured patients are sharing that space with a much bigger public buyer. Publicly funded planned surgery per person is still 5.6% below FY2018 even after the FY2025 recovery, which keeps pushing planned surgery toward privately funded care.

Written by Henry Smith · Reviewed by Smiths Insurance & KiwiSaver, licensed Financial Advice Provider (FSP712931)

New Zealand's public health system paid for less planned surgery per person last year than it did seven years ago. Not less in total. Less per person, in a country that grew 9.0% over the same stretch.

In FY2018 the public system funded 30.4 planned operations for every 1,000 New Zealanders. In FY2025 it funded 28.7, which is 5.6% less publicly funded surgery per head (QuoteHub arithmetic on NZPSHA, 6 January 2026, and Stats NZ, 19 August 2025, both).

Public hospitals are why. They did 10,250 fewer publicly funded operations in FY2025 than in FY2018. The national total still edged up, by 4,322 operations, because Health NZ bought both the shortfall and the growth from private hospitals (NZPSHA).

So one in five publicly funded operations now happens in a private theatre. Seven years ago it was one in ten.

The surgery being counted is planned surgery: hips, knees, cataracts, hernias, some heart procedures, the cases that sit on a waiting list rather than arrive by ambulance. The unit is a surgical discharge, one completed hospital stay that included surgery, and this piece calls it an operation throughout.

Those counts come from Elective Surgery 2018-2025, a four-slide pack published on 6 January 2026 by the New Zealand Private Surgical Hospitals Association, the industry body for private surgical hospitals. It credits "Health NZ Statistics on publicly funded elective hospital discharges, and NZPSHA member survey on elective discharges". The pack shows counts and nothing else. It never divides one line by another, never totals a year and never adjusts for population, so every percentage in this article is ours and every raw count is theirs.

What does this mean if you are on a waiting list?

These are national numbers, not a read on any individual case. At the level of the whole country, three things follow.

The pool of publicly funded operations New Zealanders are competing for has shrunk against the size of the population, and that is the arithmetic underneath a longer queue.

The public system's own answer has been to rent theatre time in private hospitals, so the route many people picture as the alternative to the public system is now a fifth of the public system.

And those private theatres are the same ones health insurers and ACC book. There is one pool of private operating capacity in this country, and it now has a public buyer in it nearly twice the size it was in 2018.

One in five publicly funded operations happens in a private theatre

Health NZ funded 152,622 planned operations in FY2025: 122,083 in its own hospitals and 30,539 bought from private ones. That puts the private share of the publicly funded programme at 20.0%, against 10.8% in FY2018 (QuoteHub arithmetic on NZPSHA).

The climb was not smooth, and the peak has already passed. The share sat at 14.7% in FY2022, jumped to 19.5% in FY2023, peaked at 20.8% in FY2024, then eased to 20.0% in FY2025 as public hospitals recovered output faster than outsourcing grew, on the same counts.

Chart: QuoteHub calculation from NZPSHA, Elective Surgery 2018-2025. Each bar divides the outsourced count by every Health NZ funded discharge in the same year.

Year	Public facilities	Private facilities	Total Health NZ funded	Private share
FY2018	132,333	15,967	148,300	10.8%
FY2019	123,113	19,531	142,644	13.7%
FY2020	112,778	19,797	132,575	14.9%
FY2021	127,321	21,167	148,488	14.3%
FY2022	105,748	18,252	124,000	14.7%
FY2023	106,915	25,981	132,896	19.5%
FY2024	113,070	29,696	142,766	20.8%
FY2025	122,083	30,539	152,622	20.0%

Facility counts from NZPSHA, Elective Surgery 2018-2025. The total and share columns are QuoteHub arithmetic.

The split of that growth is the part worth sitting with. Since FY2018 the publicly funded programme has grown by 4,322 operations in total, while the work bought from private hospitals has grown by 14,572, on the same counts. Private theatres supplied 3.4 times the entire net growth of publicly funded surgery: all of the growth, plus cover for the 10,250 operations public hospitals stopped doing.

Two in three planned operations in New Zealand are already private

The pack's "Other" line is surgery in private hospitals paid for by anyone except Health NZ. It grew 23.1%, from 163,958 operations in FY2018 to 201,784 in FY2025 (NZPSHA). That is 1.65 privately funded operations for every one a public hospital performs.

FY2025 elective operations	Count
Public hospitals, paid by Health NZ	122,083
Private hospitals, paid by Health NZ	30,539
Private hospitals, paid privately	201,784
Every elective operation in New Zealand	354,406

Counts from the same NZPSHA pack. The total is QuoteHub arithmetic.

Private hospitals hosted 232,323 of those 354,406 operations. That is 65.6% of all planned surgery in New Zealand, up from 57.6% in FY2018 (QuoteHub arithmetic on NZPSHA).

A private majority is not new. Private money already paid for 52.5% of planned surgery in FY2018, against 56.9% now, on the same counts and the same arithmetic. What the seven years changed is the size of the margin, and the public system's reliance on private theatres for a fifth of its own work.

The pack does not say who is behind "Other". In practice that money is health insurers, ACC and people paying their own bills.

What does this mean if you have health cover?

If you hold health insurance for planned surgery, these counts say something blunt. You are not buying a fallback to the public system. You are buying access to the majority of it.

It cuts both ways. Health NZ's purchases from private hospitals nearly doubled between FY2018 and FY2025, from 15,967 operations to 30,539 (NZPSHA), so privately funded patients are booking the same theatre lists as a public buyer close to twice the size it used to be.

For the cohort relying on the public route alone, the per-person numbers are the queue. Our research on treatment costs and waiting times tracks the wait procedure by procedure, and our treatment costs tool sets out what the private route involves for common operations.

How solid are these numbers?

The source is a slide pack from the private hospitals' own industry body, which is worth holding in mind (NZPSHA).

A discharge is also not exactly one operation. One hospital stay can include several procedures, the rules for counting day cases can shift, and nothing here adjusts for how hard the operations are. Outsourced work tends to be high-volume and simpler, so 20.0% of discharges is not 20.0% of surgical work by cost or difficulty.

The publicly funded counts are credited to "Health NZ Statistics", but the pack gives no link and we could not find a Health NZ publication carrying those exact numbers. We are taking them on trust. The private "Other" counts come from a survey of NZPSHA's own members, and there is no official series to check them against at all.

The data covers planned surgery only. Emergency surgery, which fills much of public theatre time, is left out, so nothing here says most New Zealand surgery overall is private. The pack never states which months its financial years cover, either. We assume July to June.

The population side has its own wobble. The 2018 figure of 4,885,300 comes from an older Stats NZ series that was revised upward after the 2018 Census (Stats NZ, 14 August 2018), and the 5,324,700 for 2025 is still provisional in the Stats NZ estimate cited at the top. Either revision would move the per-person figures slightly. Neither would change the direction.

Finally, the pack does not split "Other" between insurers, ACC and self-payers, so we cannot say how much of that privately funded surgery is paid by insurance.

What this means for your cover

Public waiting lists and what private treatment costs are the two numbers health cover is bought against. Health insurance in New Zealand

Sources

Every source below was read and checked on 21 August 2026.

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