Abstract
New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs).Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues:1. Loss of autonomy2. Inadequate management funding and support3. Inconsistency and variations in contracting processes4. Lack of publicity and advice around enrolment issues5. Workforce and workload issues6. Financial risksOn the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms.The key lessons concern:• the need for a national primary health care strategy• active engagement of general practitioners and their professional organisations• recognition of implementation costs• the need for infrastructural support, including information technology and quality systems• robust management and governance arrangements• issues related to critical mass and population/distance trade offs in service delivery models
Highlights
New Zealand's health sector has been subject to continual change since the early 1990s, undergoing three significant restructures within 10 years
Over 75% of New Zealand general practitioners (GPs) are members of over 30 Independent Practitioner Associations (IPAs) which vary in size from 7 to 340 GP members, and there is an IPA Council of New Zealand (IPAC)
The Royal New Zealand College of General Practitioners (RNZCGP) published an overview of the Primary Health Care Strategy implementation in April 2003 expressing concerns regarding the vulnerability of primary care early on in the reforms [30]
Summary
New Zealand's health sector has been subject to continual change since the early 1990s, undergoing three significant restructures within 10 years. Funding was to be allocated between DHBs according to a formula based on the local population weighted for relative health need Coupled with these structural changes a series of national strategies have been developed to guide the system; these identify objectives and priorities for improving health and independence levels in the population, aim to reduce the 'health gap' between Maori and non-Maori, and specify how services should be delivered [10]. The vision involves a new direction for primary health care with a greater emphasis on population health and the role of the community, health promotion and preventive care, the need to involve a range of professionals, and the advantage of funding based on population needs rather than fee for service This reflects a desire by the New Zealand government to reduce health inequalities between different population groups, and protect and promote the health of. Progressive introduction of the new funding means that those aged 18–24 were covered from 1 July 2005, and for 46–64 years are covered from 1 July 2006
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