5.1 The state of the health system Ngā pūnaha hauora huri noa i te ao

5.1 The state of the health system | Ngā pūnaha hauora huri noa i te ao

5.1.1 Health spending | Ngā whakapaunga hauora

When the pandemic arrived, New Zealand's health expenditure was close to the OECD average. Figure 40 shows health expenditure in OECD countries, and a selection of other middle- and high-income countries, in 2019 and 2023. Spending is measured in US dollars and is adjusted for differences in prices between countries (that is it is PPP, or purchasing power parity, adjusted).

Before the pandemic, New Zealand's health expenditure was a little over US$4,300 per person per year. This was a little more than countries like Italy, Spain and South Korea, but less than Australia (US$5,400), Japan (US$4,800) and the United Kingdom (US$5,400). Northern European countries (for example, $US6,000 in Sweden and US$7,000 in Germany) generally spend the most on health. The United States, which spends almost US$11,000 per person per year, is a significant outlier.

Most countries increased their health expenditure (in PPP terms per capita) between 2019 and 2023. New Zealand saw one of the largest increases, from US$4,345 to US$5,319.

Figure 40: Per-capita health expenditure across the OECD

In US dollars per person, PPP adjusted, 2020 values, in 2019 and 2023 (or closest year)

Source: Organisation for Economic Cooperation and Development, OECD Health Statistics 2025, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html  
Note: Includes some non-OECD countries, such as Argentina and Cyprus.

Countries spend different amounts on healthcare based, in part, on what they can afford. Figure 41 shows health expenditure relative to the size of the country's economy. New Zealand spent around the OECD average on health relative to the size of its economy in 2019. New Zealand's expenditure (as a proportion of GDP) rose significantly between 2019 and 2023.

Figure 41: Health expenditure as a percentage of GDP across the OECD

In 2019 and 2023 (or closest year)

Source: Organisation for Economic Cooperation and Development, OECD Health Statistics 2025, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html  
Note: Includes some non-OECD economies, such as Brazil and South Africa.

5.1.2 Human resources | Te kāhui kaimahi

New Zealand had 3.4 physicians (medical doctors) per 1,000 inhabitants in 2019, close to the OECD average (Figure 42). While northern European countries tend to have more physicians (for example, Sweden had 4.3 physicians per 1,000 inhabitants, Austria had 5.5), countries like the United States, Canada and the United Kingdom have fewer physicians (2.6, 2.7, and 2.9, respectively). Italy saw a huge increase in physicians over the period of the pandemic, increasing from 4.1 per 1,000 inhabitants in 2019 to 5.5 in 2023. The increase in New Zealand was from 3.4 in 2019 to 3.7 in 2023 (an increase of 8.3%, or 2.0% per annum).

Figure 42: Physicians per capita across the OECD

Per 1,000 people, 2019 and 2023 (or closest year)

Source: Organisation for Economic Cooperation and Development, Healthcare human resources, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html  
Notes: Physicians includes Generalist medical practitioners (ISCO-08 code: 2211) [General practitioners, and other generalist (non-specialist) medical practitioners]; plus: Specialist medical practitioners (ISCO-08 code: 2212) [General paediatricians, Obstetricians and gynaecologists, Psychiatrists, Medical group of specialists, Surgical group of specialists, and Other specialists].

The pattern for nurses was similar (Figure 43). In 2019, New Zealand had around 10 nurses per 1,000 inhabitants, more than countries like the United Kingdom (8.2) and Korea (7.9), but fewer than Sweden (10.9), Australia (12.2) and Switzerland (18). This number had increased to 11.7 by 2023 (an increase of 14%, or 3.4% per annum).

Figure 43: Nurses per capita across the OECD

Practising nurses, per 1,000 people, 2019 and 2023

Source: Organisation for Economic Cooperation and Development, Healthcare human resources https://www.oecd.org/en/data/datasets/oecd-health-statistics.html

5.1.3 Physical resources | Rauemi hanganga

In terms of physical resources, New Zealand had comparatively few hospital beds in 2019, around 2.55 per 1,000 people. This was similar to Canada (2.52), the United Kingdom (2.46), and Sweden (2.1). By contrast, Asian countries like Japan and Korea had more than 12, while European countries like Germany and Austria had around 7.

How many in-hospital patients can be treated depends on both the number of beds and the length of stay. Patients in Japan and Korea tend to stay longer in hospital than those in European and North American countries.

Figure 44: Hospital bed capacity across the OECD

Total hospital beds (public and private) per thousand people, 2019 and 2023

Source: Organisation for Economic Cooperation and Development, Healthcare provider resources, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html

People with very serious COVID-19 illness often require artificial ventilation. Ventilators are typically available in intensive care units (ICUs), along with other life-preserving equipment, but can be used outside an ICU context.

Cross-country data on ventilator capacity is not available. However, the OECD does have data on ICU beds. According to its data for 2019, New Zealand had the fewest ICU beds at around three per 100,000 population (Figure 45) – roughly 150 beds.

Figure 45: Intensive care unit capacity across the OECD

ICU beds, per 100,000 people, 2019 and 2023

Source: Organisation for Economic Cooperation and Development, Healthcare provider resources, https://www.oecd.org/en/data/datasets/oecd-health-statistics.html

However, this comparison is not definitive in terms of a country's ability to cope with a COVID-19 outbreak. In normal times, New Zealand has been able to meet ICU and ventilator demand with these resources. A pandemic like COVID-19 is likely to overwhelm normal-time capacity. What matters under such circumstances is the ability to 'surge' – to temporarily raise supply to the required level. An editorial in the New Zealand Medical Journal in 2021 estimated New Zealand's effective surge capacity at 243 ICU beds (about five per 100,000 population).¹⁸

¹⁸ Paul J Young, Alex Psirides and Stephen Streat, 'New Zealand's staffed ICU bed capacity and COVID-19 surge capacity', *New Zealand Medical Journal*, Vol 134 No 1545 (12 November 2021), https://nzmj.org.nz/media/pages/journal/ vol-134-no-1545/new-zealand-s-staffed-icu-bed-capacity-and-covid-19-surge-capacity/1960b41fc-1696471381/new-zealands-staffed-icu-bed-capacity-and-covid-19-surge-capacity-open-access.pdf