Background A continuously operating survey can yield advantages in survey management, field operations, and the provision of timely information for policymakers and researchers. We describe the key features of the sample design of the New Zealand (NZ) Health Survey, which has been conducted on a continuous basis since mid-2011, and compare to a number of other national population health surveys. Methods A number of strategies to improve the NZ Health Survey are described: implementation of a targeted dual-frame sample design for better Maori, Pacific, and Asian statistics; movement from periodic to continuous operation; use of core questions with rotating topic modules to improve flexibility in survey content; and opportunities for ongoing improvements and efficiencies, including linkage to administrative datasets. Results and discussion The use of disproportionate area sampling and a dual frame design resulted in reductions of approximately 19 percent, 26 percent, and 4 percent to variances of Maori, Pacific and Asian statistics respectively, but at the cost of a 17 percent increase to all-ethnicity variances. These were broadly in line with the survey's priorities. Respondents provided a high degree of cooperation in the first year, with an adult response rate of 79 percent and consent rates for data linkage above 90 percent. Conclusions A combination of strategies tailored to local conditions gives the best results for national health surveys. In the NZ context, data from the NZ Census of Population and Dwellings and the Electoral Roll can be used to improve the sample design. A continuously operating survey provides both administrative and statistical advantages.