A migrant worker’s death in the Cook Islands is sharpening attention on how medical evacuations are organised and funded for foreign workers in the Pacific, at a time when medical costs worldwide are expected to keep rising. Community leaders and industry observers say the case underlines practical and financial gaps in emergency transfers from small island states and raises issues for New Zealand insurers and employers that arrange health and evacuation cover for Pacific-based staff.
According to RNZ’s report, the current debate stems from the recent death of an expatriate worker who was critically injured in a hit-and-run in Rarotonga last month. Leaders of migrant communities say the incident has exposed uncertainty about how quickly foreign workers can be transferred to hospitals overseas and who is responsible for significant evacuation expenses. Cook Islands officials have signalled that existing medical evacuation settings for foreign workers will be reviewed in response. Migrant representatives are urging that insurance arrangements and clear funding responsibilities be considered as part of that process. Budi Setiawan, president of the Indonesian community in the Cook Islands, said the incident has led many foreign workers to reassess their position. “It really is an eye-opener to us, too. We never know what the future brings,” Setiawan said, as reported by RNZ.
Setiawan said there are about 300 Indonesians living in the Cook Islands, including in the Pa Enua outer islands, and that the community has begun discussing potential responses if one of their members requires urgent care offshore. He added: “We are trying to solve this issue among ourselves. If something happens to us, what should we do as a community?” Setiawan said the questions are not limited to clinical capacity but also involve cost, procedures, and time. “For matters such as this, when it is urgent it is important to act swiftly, ‘we may be foreigners, but we pay tax, too,’” he said. He added that foreign workers expect equitable treatment. “We contribute to the Cook Islands community as well, and we are hoping to get the same treatment, at least,” he said.
The Cook Islands Fijian Association (CIFA) has voiced similar concerns, linking the incident to a broader lack of structured financial protection for foreign workers. CIFA president Ravinesh Swamy has proposed that authorities look at compulsory health or evacuation cover for migrant workers, with costs met by employers, recruitment agencies, or worker contributions, or a mix of these. “If the government, immigration, and the people involved create an insurance policy for all foreign workers. If the companies can pay it or not, or if people coming from Fiji, for example, could also have their own insurance policies, that would be great,” he said, as reported by RNZ.
Swamy suggested that small automatic deductions could be used to build an emergency reserve. “One dollar per pay goes in there, and if something critical happens, like what has happened recently, then at least the money is there. At the end of the day, money is involved,” he said. He said limits in the existing worker protection framework have been noted for years and suggested that a workers’ union, similar to one that operated previously in the Cook Islands, could help represent migrant interests. In the absence of more formal arrangements, he said, foreign workers “have no medical/ health security in the Cook Islands.” The discussion points to potential changes in employer obligations, visa-linked insurance requirements, and the structure of cross-border medical evacuation benefits.
The questions arising from the Cook Islands case come as medical cost inflation remains elevated globally. The WTW 2026 Global Medical Trends Survey projects worldwide medical costs to increase by 10.3% in 2026, following an expected 10% in 2025 and 9.5% in 2024. Asia-Pacific is forecast to record the highest medical trend, with costs projected to rise 14% in 2026 after 13.2% in 2025. WTW reports that 56% of insurers expect medical cost trends to increase further, and 55% anticipate that higher trend levels will persist for more than three years. Insurers identify the main drivers as the adoption of new medical technologies, continued pressure on public health systems, developments in pharmaceuticals, and fraud, waste, and abuse. These projections suggest continued pressure on pricing for medical and evacuation benefits. Potential responses could include changes to limits and cost-sharing, closer integration of evacuation protocols with network hospitals, and clearer pre-agreed pathways for handling high-cost cases.
