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What It Costs to Leave Things as They Are

New Zealand’s rural communities continue to face an old problem - one  that has outgrown the workarounds.


The 2023/24 NZ Health Survey found that visits to GPs continue their downward trend nationally, with emergency department attendance rising from 15.0 to 17.8 percent of adults in a single year.1 That shift - from managed primary care to unplanned acute care - carries a direct cost implication, because the two settings are not equivalent in price.


For rural communities, the gap is wider still. The Rural Urgent Unplanned Care (RUUC) Report 2025 documents that rural residents delay seeking care and present with more advanced illness than their urban counterparts.  Underlying drivers included long travel distances, work and caregiving pressures, and limited after-hours availability.2  The Sapere analysis cited in the same report found that rural practices face higher operating costs than urban ones, while the capitation funding formula does not account for this, leaving practices critically underfunded relative to the populations they serve.3


The NZ Health Survey also found that one in four adults could not see their GP in a timely manner, and one in six avoided their GP due to cost.1 In communities without a resident GP, those national averages understate the local reality considerably.


Who Bears the Cost


When primary care is not locally available, the cost does not disappear - nor should people think of this as a “saving”. 


The costs shift onto individuals and whānau, and are cycled back into the public system at a later and more expensive point. 


In addition, people in remote and rural communities must fund significant petrol expenses, accelerated vehicle depreciation and the economic cost of significant missed time at their income-producing occupation, if employed. With global petrol prices under pressure at this time, these costs become a burden placed squarely on the shoulders of community members.

For a Northern Coromandel resident managing a chronic condition, an average return trip to Thames for a routine appointment is approximately 180km. At the IRD mileage rate of $1.17 per kilometre4 - that is $210 in vehicle running costs alone - before any co-payment or time away from work. For monthly appointments, that is $2,520 per year. 


The Colville statistical area has a median personal income of $27,100, compared with $41,500 nationally5 and residents aged 65 and over make up 31.9 percent of its population, compared with a national average of 16.6 percent.6  For the significant proportion of these residents living on NZ Super of $556.73 per week after tax,7 $210 is not a minor expense.


Such inequities relating to the financial cost of access to healthcare for New Zealand’s rural residents are well documented 8-13, but for older residents, the costs associated with extra distances have a further dimension. 


When local services are not available, the decision to remain in the community becomes harder to sustain. When a person leaves - for family support, for proximity to services, or for a residential care placement - the public system absorbs a cost that is proportionally much larger than what local primary care would have required. 


What It Costs the System


NZ Treasury data sets out the cost at each point in the system:14

Setting

Per day

Per year (indicative)

Home-based community care

~$20

~$7,300

Aged residential care

~$235

~$85,775

Hospital bed

~$1,000

~$365,000


When considering that rural residents delay seeking care and present with more advanced illness (RUUC Report 2025 ), and  what each point in the system costs (NZ Treasury documents), the gap between those two findings is where the rural communities of the Northern Coromandel live.


The difference between $7,300 per year for community-based care and $365,000 per year for a hospital bed is the direct financial consequence of whether or not appropriate local infrastructure exists.


What TCP’s Wellbeing and Education Centre Changes


The costs documented above are not unique to the Northern Coromandel . What is notable about our region however, is that a practical, multi-dimensional response is already underway - and it addresses these problems not as isolated issues but as the interconnected system they are.


On emergency response: TCP’s Wellbeing and Education Centre (WEC) includes a dedicated ambulance garage designed to accommodate our local First Response Unit (CFRU). Co-locating the ambulance garage alongside the WEC  allows local volunteers to work in partnership with visiting clinicians and community health workers, improving response times and continuity of care for local residents. The WEC’s primary health infrastructure provides a clinical base for visiting practitioners alongside this emergency capability - addressing both the response gap and the absence of local primary care from the same site.


On the geography of access: The WEC is located in Colville, which sits at the practical centre of the Northern Coromandel Peninsula. Communities further north - Port Charles (45.7km from the nearest comparable facility to the south, approximately 71 minutes one way by road) and Port Jackson (55.4km, approximately 87 minutes one way) - rely on Colville as the nearest service point, and a key connection point in an emergency. Thames-Coromandel District Council’s own road conditions data documents regular closures across general and Northern Coromandel roads, particularly in adverse weather. The Northern Coromandel and/or parts of it, are frequently ‘cut off’.


Distance in kilometres on this peninsula is not a reliable measure of access time.  Roads are largely unsealed, are hilly and windy.  When roads close, there is no next available service point.15


On housing and aging in place: There is a housing dimension behind all of the above. Many people who can no longer manage their family home as they age could manage a smaller, independent living scenario - and aspire  to remain in the community they know and are connected to, if that option existed locally. 

In addition the region has very low availability of rental housing, and high rental to income rates.  Families and workforce  find it very difficult to find suitable, affordable and long-term housing. 


The absence of appropriate housing is not a separate problem from the health access problem. It feeds directly into demand for aged residential care. 


It also compounds the workforce shortage: without housing for care workers, there is no care workforce, and home-based care in rural areas remains chronically under-resourced. 


The WEC’s approach treats these as interconnected constraints that share a common resolution. Developing appropriate independent living options as part of a co-located community facility addresses the housing gap, the workforce gap, and the health access gap simultaneously.


On direct resident costs: Services closer to home reduce the frequency and cost of travel. A resident who accesses a visiting specialist at the WEC rather than travelling to Thames saves $210 per visit in vehicle running costs alone. For monthly appointments, that is $2,520 per year against a $28,950 annual income for a single person on a benefit.


On system cost: The WEC is not asking the health system to spend more. It is offering a more efficient point of delivery for spending that is already occurring - and, in some cases, for spending that could be avoided if the conditions that make escalation more likely were addressed earlier.  Enabling local health care in rural regions removes considerable financial and resourcing burden from hospitals and specialist care. 

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The Northern Coromandel has been managing this gap through volunteer effort, improvised spaces, and individual resilience for a long time. The data reviewed here suggests the cost of continuing to do so is not static. It accumulates in callouts, in residential care placements, in return trips to Thames, and in the quiet departure of older residents who have run out of local options. The latter puts additional strain on families trying to maintain support of their loved ones over greater distances, and can itself lead to further depopulation.  What the numbers show, taken together, is that inaction has a price - and that price is being paid now, in pieces, by the people least able to absorb it.

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Sources

All sources are publicly available unless noted as TCP archive. Colville-specific extrapolations are indicative. Inferences connecting data sets are noted as TCP’s own reasoning and are flagged for verification.

2.  Rural Urgent Unplanned Care (RUUC) Report 2025, p.12, paras 22-23 - Hauraki-Thames-Coromandel-Waikato Rural Health Network - https://htrhn.org.nz/wp-content/uploads/2025/06/FINAL-REPORT-RUUC-Final-Recommendations-paper-Published.pdf

3.  Sapere Research Group - rural practice funding analysis, cited in RUUC Report 2025, p.16, para 37 - https://htrhn.org.nz/wp-content/uploads/2025/06/FINAL-REPORT-RUUC-Final-Recommendations-paper-Published.pdf

5.  Colville statistical area median personal income $27,100 vs $41,500 nationally - 2023 Census, Stats NZ - https://tools.summaries.stats.govt.nz/places/sa2/colville/

6.  Coromandel-Colville Community: 1,068 residents aged 65+, 31.9% of population, median age 55.0 - Infometrics 2026, 2023 Census data - https://regions.infometrics.co.nz/coromandel-colville-community-2026/census

7.  NZ Super rates, April 2026 - Sorted.org.nz - https://www.sorted.org.nz

8.  Rural out-of-pocket cost study, rural Central Otago NZ - Australian Health Review, CSIRO Publishing, 2016 - https://www.publish.csiro.au/ah

9.  Health NZ Gazette, 18 June 2025 - Maximum resident contribution, Thames-Coromandel District from 1 July 2025

10.  Average rest home length of stay - MoneyHub NZ, June 2025 - https://www.moneyhub.co.nz

12.  NASC wait times - NZCCSS Aged Care Action Plan - https://www.ps.org.nz

13.  West Coast/Buller hospital wait times for residential placement - RNZ / Aged Care Association, April 2026 - https://www.rnz.co.nz

14.  Care cost hierarchy - NZ Treasury 2024 - https://www.treasury.govt.nz

15.  Thames-Coromandel District Council road conditions - current closures - https://www.tcdc.govt.nz/Our-Services/Transport-Roads-and-Road-Safety/Road-and-Highway-Conditions

 
 
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