Book Review: Continuity Amid Chaos: Health Care Management and Delivery in New Zealand

Abstract

CONTINUITY AMID CHAOS: HEALTH CARE MANAGEMENT AND DELIVERY IN NEW ZEALAND Robin Gauld (ed.) Dunedin: Otago University Press, 2003, 303 pp. $NZ54.95 (paperback). The editor of this collection, Robin Gauld, rightly claims that, while there is now a reasonable body of literature about health, health care and the health system in New Zealand, 'there have been limited contributions from health-care practitioners, and there is a dearth of material around how health care is actually managed and delivered' (p. 13). The collection seeks to redress this and, in the main, it has achieved this goal. Another reason given for the collection is the interest in the New Zealand health system from both researchers and policy makers. It is claimed on the back cover that New Zealand is the 'most restructured' of any of the health systems in the world, having put in place four difference structures since 1989. This book, then, is a record of these turbulent times. The book canvases both the local and the national health scene, and tries to be inclusive of a range of health care. Many of the chapters are case studies of particular health services in specific localities, for example, the challenges of running a district health board, a Taranaki experience in Maori health development, managing a rural community health trust, tackling the rise of infectious diseases in Auckland, an analysis of the deinstitutionalization process in mental health, changes in primary health care, and the delivery of disability support services in the community. Chapters that cover the national health care scene include an examination of the organizing of the National Cancer Screening Programmes in New Zealand, evaluating integrated care projects and managing surgical waiting lists. For sociologists there are a number of chapters that will be of particular interest. In 'It's not my home anymore: A critique of in-home care', Beatrice Hale discusses the shift from institutional care for older people to the implementation of a policy of 'ageing in place'. She argues that the 'popular ideological value of home care obscures the value of well-managed residential care' (p. 254). This chapter provides a comparison of the strengths and limitations of both in-home care and residential care for older people, and the voices of recipients are used to highlight these. This is a timely and insightful discussion given the ageing population in New Zealand and other similar countries. …