Box 1 The New Zealand health system New Zealand’s 1938 Social Security Act was the world’s first attempt to create a “national health service”. Doctor resistance meant the intent was never realized. Public hospitals salary all staff and are free of patient charges. General practitioners are largely in private practice and act as gatekeepers. They receive considerable government subsidies but charge most patients a fee per consultation, creating an access barrier [28]. The Government contributes 83% of total health expenditure, as in the UK. Around 40% of public hospital specialists have a separate private practice, often considered to be attractive in terms of public sector workforce retention [29]. The parallel private system means patients of better means are able to circumvent public hospital waiting times or access treatments considered to be lower priority in the constrained public sector [30].