About the fund
The High Cost Treatment Pool (HCTP) is funding available for patients requiring high cost treatment or procedures that are not otherwise funded or provided by the public health system in New Zealand.
Applications to the HCTP can only be made by a District hospital specialist who will provide recommendations for treatment and supporting documentation.
Before the application is accepted it will be reviewed and assessed by a panel of Te Whatu Ora Clinical Leaders, subject matter experts and the proposed treatment provider.
Applications will only be considered for procedures or treatments not available in the New Zealand public health system.
The fund is only available to people who are New Zealand citizens or permanent residents.
Other criteria used as a guide for assessing applications includes:
- The treatment must not be available from any public hospital in New Zealand (or under any existing contractual arrangement).
- The treatment must have proven efficacy through appropriate clinical trials, and preferably has also been established as effective when applied in regular practice.
- The treatment is well-established and is not an experimental form of treatment.
- 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
- 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.
- 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 Te Whatu Ora priorities.
- 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.