Originally published by Andrew Bevin for the Newsroom. on 30/06/2026
‘Warning over what major insurer’s proposal means for women’s healthcare‘
A major shake-up in how the country’s largest health insurer approaches gynaecological care has practitioners and advocates worried about poorer outcomes for an already under pressure form of healthcare.
But Southern Cross Health Insurance says the approach will protect affordability and access to gynaecological care for its members without compromising outcomes.
Southern Cross’s customers make up 60 percent of New Zealand’s health insurance market by numbers and 70 percent by value, making it the largest funder of healthcare that isn’t part of the Government.
The New Zealand Gynaecology Association was created to discuss the new model and has subsequently applied to the Commerce Commission for approval for its members to collectively negotiate with the insurer and private hospitals.
Southern Cross’s chief of healthcare partnerships Russell Simpson says it has been engaging with providers on the transition of gynaecology surgery into its affiliated provider programme “to address sustained cost increases under the current fee-for-service model, and to help protect affordability and access to gynaecological care for our members over the long term”.
Southern Cross has had its affiliate provider programme in place for nearly 30 years, allowing it to access certain healthcare services at agreed prices.
This means its customers know up-front how much their co-payment will be, if anything.
The proposal would mean private hospitals acted as head contractors, negotiating with gynaecologists as subcontractors.
These hospitals would then be paid bundled fees, procuring gynaecology services from individual clinicians for what the association says is significantly reduced compensation.
The association says communications with the insurer imply there will be one price set for each procedure.
But some are warning such programmes aren’t a great fit for gynaecology.
The New Zealand Gynaecology Association told the Commerce Commission the proposal would see clinically appropriate procedures being excluded – meaning some patients best served with multiple procedures in one operation would require repeat surgery and poorer outcomes.
It also says the proposal doesn’t appear to properly account for variation in surgical complexity.
The association says it isn’t seeking to prevent Southern Cross from implementing its proposal, rather to ensure any decision is based on fully informed decision-making with proper clinical and market input.
It isn’t alone in its concern over the new model.
Endometriosis risk
In a submission to the commission, Endometriosis New Zealand chief executive Tanya Cooke says the charity doesn’t take a position on commercial arrangements between Southern Cross, hospitals and gynaecologists.
Cooke says its interest is in ensuring that any future contractual framework supports patient access to the best possible endometriosis care.
Endometriosis is chronically under-diagnosed because of medical gender bias and symptoms that can be written off as normal, such as intense period cramps.
Whatever arrangement is adopted, she says it mustn’t create incentives that disadvantage patients with complex disease.
“In some cases, the full complexity of a patient’s condition may only become clear during surgery.
“Endometriosis New Zealand is concerned about any model that could create incentives to avoid complex surgical cases, split procedures that could safely and appropriately be carried out together, reduce access to experienced endometriosis surgeons, or limit patient choice.”
As such, the organisation says any arrangement must include mechanisms for complex and unpredictable cases, intraoperative findings and exceptions, with patient choice protected, particularly in terms of accessing clinicians with recognised expertise in complex endometriosis.
“Any reduction in capacity in the private system threatens to put additional pressure on the already-stretched public system. A reduction in private capacity or specialist availability may be felt more sharply outside major centres where shortages are already acute.”
The Urogynaecological Society of Australia raises similar concerns.
Submitting in favour of the collective negotiation, chair Dr Bernadette Brown says that from a clinical perspective, the most significant concern is that the proposed reimbursement structure may influence surgical decision-making in ways that conflict with evidence-based practice.
“Funding mechanisms should not determine the scope of surgery offered to patients when clinical evidence supports combined procedures. Decisions regarding surgical management should remain between the patient and their treating specialist, based on clinical need and best available evidence.”
She says Southern Cross’s proposal that certain procedure codes cannot be claimed together is particularly concerning.
“I understand that the procedure code for an anterior vaginal wall repair cannot be claimed concurrently with codes for posterior vaginal wall repair or apical suspension procedures. In some circumstances, these procedures may also not be claimable alongside hysterectomy procedures.”
Brown says these restrictions do not reflect contemporary understanding of pelvic floor dysfunction, with growing evidence that isolated compartment repairs may increase the risk of recurrent prolapse and repeat surgery.
“Similarly, the proposed coding restrictions appear to limit the ability to perform continence procedures concurrently with prolapse surgery.
“This is particularly concerning given that up to 80 percent of women with advanced prolapse may have occult stress urinary incontinence that only becomes clinically apparent once the prolapse is corrected.”
Though not involved in gynaecological health, Ophthalmology New Zealand has similar concerns about quality of care under the proposed model.
In a submission, it says it is concerned that downward pressure on specialist remuneration may have unintended consequences for the quality of care.
“Economic incentives within healthcare systems can influence clinical behaviour, including consultation length, service intensity, and resource allocation decisions. Maintaining high-quality specialist care requires remuneration structures that reflect training, expertise, complexity, and clinical risk.”
Balancing act
But Southern Cross’s Simpson says supporting women to access timely, appropriate gynaecological care is a priority for the insurer.
“Any changes we are seeking to agree with providers are focused on balancing access to care with fairness, sustainability, and long-term value for our members.
“The proposed transition of gynaecology surgery into our affiliate provider programme is intended to support continued access to care in a sustainable way, and we are confident it will support, and not compromise, health outcomes for our members.”
The issue of specialist costs was raised by one anonymous submitter, who says their family had been adversely affected financially by engaging with private gynaecologists, and doesn’t buy arguments about women’s health.
“It isn’t hard to discern that specialists in NZ make a supernormal profit compared to many comparable countries.”
They say comparisons with the Australian private healthcare system have shown it to be substantially cheaper across the Tasman, with surgery costs quoted at 25 percent to 30 percent cheaper.
“Unfortunately, NZ private insurance does not cover treatment in Australia, and we were thus forced to pay 20 percent of a very large bill from the gynaecologist in NZ.”
“It appears to me that the New Zealand Gynaecological Association tries to defend such high payments for their specialists by saying it’s all about patient care/women’s health, its offensive actually that such a trite response is given when their unjustifiably high payments are putting up health insurance costs for all NZers who want to take it out to protect their own health.”
The Commerce Commission has a current decision due date of October 22.