Just over a year ago the health sector went cap in hand asking for funding to deal with rising immigration - but the Government shortchanged them to the tune of quarter of a billion dollars.
The shortfall is revealed in a briefing from the Ministry of Health to the Health Minister, which says to deal with immigration, as well as wage and cost increases, it needed an extra $644.8 million.
The information was forced out by the ombudsman, realeased to the yeswecare.nz campaign after a year-long battle with the ministry.
"DHBs face significant pressure in Budget 2016, due to the additional impact of net migration on population growth and aging, and anticipated wage pressure," it said.
It calculated a $379 million need for population pressure, $190.5 million to cope with wage increases, and $75.3 million to fund rising costs. All up - $644.8 million.
But in Budget 2016, they were given $400 million - a more than $250 million shortfall.
The ministry even warns that without the full funding, access to healthcare is on the line.
"It is important that health funding growth aligns with population changes if we are to continue the expectation upon DHBs to maintain existing levels of access," it said.
And the ministry said the Government's offer was going to be challenging to cope with.
"The proposed allocation of $400 million per annum still requires a challenging efficiency and productivity improvement of $244.8 million, or 2.09 percent. That efficiency expectation is greater than the challenge that DHBs have been asked to respond to in recent years."
When asked why the full amount wasn't handed over to DHBs, a spokeswoman for Health Minister Jonathan Coleman said the $644.8 million was a "wish-list" figure.
"It's a bit like a minister's wish list, but it all has to be affordable at the end of the total Budget round," she said.
As a comparison, in 2015 DHBs were given $142 million less than what they needed - an "efficiency and productivity" improvement of 1.25 percent.
Cumulatively from 2011 to 2016, DHBs have received $834.8 million less than what they asked for in this area.
Immigration last year broke records set in 2015-16, with annual net migration rising from 70,6000 to 71,305 in the 12 months ending January 31.