The Healthcare System in the Cook Islands: Organisation, Access for a Foreigner, Hospital, Emergencies and Health Risks

The Ministry of Health, Te Marae Ora, is the central operator: it runs Rarotonga hospital, primary care, public health, oral health and support services, and it publishes the national health services fee schedule. The Ministry of Health Act gives it the power to provide health services subject to a financial contribution from the patient (section 7), and to organise programmes referring eligible patients for treatment in the country or abroad (section 13), under the ministry’s patient referral policy.

The Cook Islands have no contributory health insurance scheme comparable to French Sécurité sociale: care is funded by the ministry, and the user pays according to their category. The outer islands (Pa Enua) have local facilities; a patient who needs heavier treatment is transferred from there to Rarotonga hospital (internal transfer), then, if necessary, to a New Zealand facility. The ministry also issues practising licences and refers to the medical and dental council and the nursing council. The fee schedule mentions patients referred by private practitioners, without describing any private facility.

The national fee schedule divides users into two categories. Category I includes islanders, non-islanders holding permanent or honorary resident status, non-islanders married to an islander or to a permanent resident and resident for more than six consecutive months, expatriate workers who have lived and paid tax in the Cook Islands for more than six consecutive months (their spouse and children then coming under category I), and certain non-islander pregnant women whose partner is an islander. Category II covers all visitors, including tourists and consultants for less than six months, and anyone who does not fall under category I.

On registration, every user shows their passport; workers show permanent employment with a valid permit and a taxpayer number, and category II users present proof of health insurance. Fees are paid at the time of care; staged payments can be agreed, the ministry expecting 50% of the account to be settled before discharge from hospital. Islanders and permanent residents aged 60 and over, people aged 16 and under, people in destitution or with a chronic disability and residents of the outer islands are exempt from fees. Amendments to this schedule exist, and the amounts should be confirmed with the ministry’s planning and funding unit (29664).

For a routine problem, the ministry offers a free telephone consultation with a doctor (20065 or 20066, or the Healthline 0800 1801). The Tupapa primary care centre sees patients by appointment, by telephone and dispenses medicines. Routine care (follow-up of non-communicable diseases, nursing care, dressings, baby checks) is available at the neighbourhood Puna Health Clinic: Blackrock (28 185), Tupapa (28 181), Nikao (28 186), Matavera (28 189) and Titikaveka (28 190), Monday to Friday from 8 a.m. to 4 p.m., basic services there being indicated as free.

A visitor or newcomer is well advised to register with a clinic and check their category: the schedule applies different rates to category II users, for example 40 New Zealand dollars for a hospital consultation for an adult aged 16 to 59, 20 dollars for a child or a person aged 60 and over, and 50 dollars for a visiting specialist, excluding procedures. The conversions on this page are based on the ECB reference rate.

Rarotonga public hospital offers an emergency department open 24 hours a day with paramedics, where only serious cases are admitted for definitive treatment; two operating theatres (general surgery, eye and ENT, orthopaedics, endoscopy, gynaecology-obstetrics); general medicine (cardiology, pulmonology, endocrinology, nephrology); obstetrics and gynaecology with antenatal follow-up and high-risk maternity consultations; paediatrics and neonatology; a three-bed high dependency unit; infectious diseases, acute mental health, palliative care, rehabilitation and geriatrics; and a ten-bed isolation unit including two negative pressure rooms. Imaging is not described on the clinical services page, but the fee schedule includes X-rays and ultrasounds (for example, for category II, 50 New Zealand dollars for an adult chest X-ray and 60 dollars for an abdomen-pelvis ultrasound).

The emergency number is 999, also for respiratory distress. The hospital switchboard is 22664, mental health 25664, public health 29110 and oral health 29312. For category II, the schedule prices the emergency ambulance on 999 at 800 New Zealand dollars (about €405) one way for category II a (tourists), a day in the high dependency unit at 1,000 dollars (about €506), a delivery with hospital stay at 500 dollars (about €253) and a day in a general ward at 100 dollars (about €51).

The ministry’s patient referral policy covers resident islanders, islanders returning permanently and their family, holders of a permanent residence certificate and expatriate workers under contract who have completed six months of continuous employment, with registration in the patient information system and approval from the Secretary of Health and the referral committee. It excludes non-islanders holding a work or temporary permit for less than six months, visitors and tourists, and islanders living abroad: these people bear all of their health costs.

Only New Zealand citizens enjoy free public services in New Zealand: a patient without New Zealand citizenship bears all medical, hospital and personal costs (accommodation, transport, medicines, tests, meals). The ministry may fund a one-way or return air ticket for a non-New Zealand patient if the referral is clinically urgent, if no other source of funding exists (health insurance or an employer travel benefit) and if the Secretary of Health considers it the only practical way of getting the patient there. Insurance that covers evacuation is therefore the central element of the arrangement; see repatriation and assistance.

France Diplomatie advises taking only what is necessary, in the original packaging, with a prescription giving names in the international nonproprietary name, and checking that the medicines are permitted in the Cook Islands. The Ministry of Health has published pharmacy prescription rates (addendum of 5 April 2017), the detail of which should be requested from the planning and funding unit.

Public dental services have their own schedule: for category I and category II, an examination costs 10 and 25 New Zealand dollars, an extraction of one or two teeth 30 and 70 dollars, and root treatment of a molar 150 and 400 dollars, with reduced rates for certain older people and children. Care outside the list, planned dental work and optical care should be anticipated before departure, the schedule also indicating that implant technology is not available on site. A CFE contract (the Caisse des Français de l’Étranger, the voluntary health insurance scheme for French expatriates) or international insurance can supplement these items.

France Diplomatie reminds travellers that the vaccinations of the French schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles) must be up to date, and recommends, depending on the stay, vaccines against hepatitis A, typhoid fever, hepatitis B (frequent or prolonged stays), chikungunya and dengue (active epidemic or prolonged stay in an endemic area). It describes dengue as a disease with no curative treatment, to be managed by avoiding anti-inflammatory drugs, with prevention based on protection against mosquito bites; it also mentions Zika (consultation before travel for women who are pregnant or planning a pregnancy) and typhoid fever (water, food and hand hygiene).

Dengue circulates in episodes in Rarotonga and the Ministry of Health monitors it. Its advice: empty or cover water containers, clear gutters, use repellent and wear long clothing. In the event of persistent vomiting, severe abdominal pain, bleeding or extreme weakness, seek care immediately (public health 29110, hospital 22664 outside opening hours). On hygiene, France Diplomatie recommends bottled or purified water and avoiding raw vegetables, shellfish and cold buffets.