High-cost treatment pool

The High Cost Treatment Pool is money set aside by the Ministry of Health for one-off treatments not otherwise funded by the public health system.

Applications to the High Cost Treatment Pool are only accepted from District Health Board specialists with supporting documentation and recommendations for treatment. Before the application is made there has usually been a lot of clinical discussion between the referring clinicians and the proposed treatment provider.

Treatment that may be considered includes medical treatment that is only available outside New Zealand or treatment that is only currently available outside the public health system, for example in private hospitals.

Only people who are New Zealand citizens or permanent residents may be considered for treatment funded under the High Cost Treatment Pool.

Other eligibility criteria that are used as a guide for assessing applications include:

  1. The treatment must not be available from any public hospital in New Zealand (or under any existing contractual arrangement)
  2. The treatment must have proven efficacy through appropriate clinical trials, and preferably has also been established as effective when applied in regular practice.
  3. The treatment is well-established and is not an experimental form of treatment.
  4. Failure to receive the treatment would result in serious irreversible deterioration in the patient’s condition or an inability to recover lost function, or significant impairment to normal development of a child; or
  5. Failure to receive the treatment could deny an adult with a lifelong disability access to treatment, which would lead to a marked improvement in their quality of life.
  6. The chosen treatment is cost-effective, which means that:
    • the expected long-term savings to the health care system outweigh the initial costs of the treatment
    • the dollar costs per unit of benefit are acceptable when evaluated against other Ministry of Health priorities.
  7. Treatment would lead to reasonable prospects of survival and to an improved quality of life after treatment.

Each case is also considered for exceptional circumstances beyond the criteria.

Contact

For more information about the High Cost Treatment Pool or to make an application contact: [email protected]

For information specifically about gender affirming genital reconstruction surgery through the Special High Cost Treatment Pool or to make an application contact: [email protected]

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