Financial SystemsCook Islands
Cook Islands: Pacific Catastrophe Risk Assessment
Read engagement
Institutional Performance & GovernanceOceania · New Zealand
NZ: recognising value across the emergency care continuum
Recognising value across the emergency care continuum
The engagement
Challenge to impact
01 · Challenge
The Wellington Free Ambulance (WFA) operates the only free emergency ambulance service in New Zealand, serving a broad and diverse catchment across the Greater Wellington region. Under the current funding model, WFA is only reimbursed when a patient is physically transported to hospital. This system incentivises unnecessary transports and creates strain on both ambulance services and the hospital network:
02 · Strategy
At the request of the WFA, GG International’s Government Policy and Funding Unit deployed a three-person expert team (Hon David Butcher, John Third and Matte Birchler) to assess the current funding model and propose viable alternatives. Their strategic response included:
03 · Transformation
The final report presented in December 2022 outlined a bold but logical transition pathway for the WFA, reshaping how value is recognised across the emergency care continuum. Key outcomes included:
04 · Impact
1
Patients who do not require hospital admission are still taken to Emergency Departments (EDs) due to funding constraints, contributing to ED overcrowding.
2
Elderly patients frequently endure prolonged waits, often placed in overnight hospital beds or left to find their own way home, sometimes from facilities up to 1.5 hours away.
3
The pressure to meet growing demand has driven WFA to expand its ambulance fleet, with each new ambulance costing over NZD 1 million.
4
This cycle created financial inefficiencies, patient stress, and a system unintentionally working against its own capacity goals.
5
A system-wide cost-benefit analysis, mapping patient flows, hospital capacity, and response unit utilisation.
6
Identification of perverse incentives in the transport-based funding structure that led to suboptimal patient outcomes.
7
Benchmarking with international emergency response models where payment was based on attendance and triage, not solely on transport.
8
Recommendation for the introduction of fast-response motorcycle units, enabling rapid triage without full ambulance deployment, especially in non-critical incidents.
9
Proposal for a new funding model based on: Per patient attended, not per patient transported. Recognition of hospital cost savings (e.g., avoiding $1,000+/night inpatient admissions). Improved triage leading to more effective resource allocation.
10
Per patient attended, not per patient transported.
11
Recognition of hospital cost savings (e.g., avoiding $1,000+/night inpatient admissions).
12
Improved triage leading to more effective resource allocation.
13
Shift in policy dialogue: Government stakeholders began re-evaluating emergency response funding based on actual clinical need rather than physical movement.
14
Operational testing: WFA began early-stage implementation of motorcycle responder units in selected urban and semi-rural areas.
15
System savings modelled: Analysis revealed potential multi-million-dollar savings annually for the public health system by reducing unnecessary hospital admissions.
16
Improved patient care: By empowering responders to assess and manage in place, elderly and vulnerable populations experienced less disruption and better continuity of care.
Gallery
From the engagement
