Almost half of all public health spending - 46.4% - was funnelled to the private sector in 2025, a new report into growing private ownership in the health system has found.
Private sector providers captured 80% of the $3 billion increase in combined Health NZ and ACC health spending since 2022/23, according to the report, Who Owns the Health System? which was released today.
Of the combined $31.9 billion Health NZ and ACC public health spend, $14.8 billion went to private sector providers in 2024/25.
"Despite strong public support for a public health system, billions in public funding now flow to an increasingly consolidated corporate health sector, dominated by private equity investors, pension funds, and asset managers," report researcher Edward Miller says.
"These corporate providers are obliged to maximise shareholder returns, which can come at the expense of safe staffing levels, wages, training, equipment, infrastructure and patient care," Miller says.
In 2025 the ‘healthcare and social assistance’ industry generated $4.5 billion in surplus before income tax (a measure of pre-tax profit), up from just $2.2 billion in 2020.
The report documents increasing corporate consolidation in five key health sectors (primary care, radiology, pathology, private hospitals and outsourced elective surgeries, aged care and community support services). It also maps ownership and identifies ways public money flows into the private health system.
Miller said the prevalence of debt-financed leveraged buyouts used by many corporate providers raises questions about the costs of outsourcing.
"Tight fiscal constraints have capped investment in public sector capacity, creating pressures used to justify outsourcing. But private providers face much higher borrowing costs than the Government. In effect we are swapping cheap and transparent public debt for expensive and often opaque private debt.
"Highly-leveraged ownership structures generate large interest expenses which reduce taxable income. These concerns are heightened by complex corporate structures spanning jurisdictions like the Bahamas, Luxembourg, Singapore and the Cayman Islands.
"Outsourcing means taxpayer dollars are helping fund the expansion of private sector capacity. We need a strategy that ensures public funds are used to build the workforce,
facilities and services of the public health system.
"The public health system rests on the promise that if you fall ill, have an accident, need an operation or have a baby, the public system is there for you.
"Increasing health privatisation undercuts this promise. It also undercuts the need for the health system to reduce barriers and health disparities experienced by Māori, because health care is increasingly driven by commercial considerations.
"The pace of privatisation is no longer a creep, privatisation has bolted," Miller says.
The report includes nine recommendations to hold private providers more accountable, to ensure the Crown’s te Tiriti o Waitangi obligations to Hauora Māori are met, and to build an equitable, accessible and high-quality public health system.
About the report
The report was commissioned by three health unions: Tōpūtanga Tapuhi Kaitiaki o Aotearoa New Zealand Nurses Union; Association of Salaried Medical Specialists Toi Mata Hauora; and the Public Service Association Te Pūkenga Here Tikanga Mahi, with support from the Centre for International Corporate Tax Accountability and Research (CICTAR).
It was published by Public Futures Aotearoa, a coalition of unions, community groups and researchers, supporting those fighting to keep public assets and services in public hands.
Notes: Corporate ownership of health sectors (see also attached fact sheet)
- Corporate ownership of the general practice sector has increased to an estimated 25% in 2025.
- Publicly funded elective surgeries in private hospitals have grown by 93% in four years to more than a billion dollars in 2024/25.
- 75% of the Diagnostics, imaging and radiology sector is owned by corporates.
- 76% of aged residential care provision is publicly-funded, with two of the Big Six providers owned by offshore private investors.
- 32% of Home and Community Support Services are provided by for-profit companies.