Zealand Health Reforms Research Articles

The future of Māori health is here – The 2022 Aotearoa New Zealand health reforms

The formal launch of Te Aka Whai Ora, the new Māori Health Authority, on 1 July 2022 marks one of the most significant health system changes in Aotearoa's recent history. The new authority joins a suite of newly created central government institutions including Te Whatu Ora (Health NZ), and Whaikaha (Ministry of Disabled People). The Hauora Māori Ministerial Advisory Committee was also created to be positioned alongside a slimmed down Manatū Hauora (Ministry of Health) focused on stewardship and incorporating a re-established Public Health Agency.

Revolving Doors: New Zealand's Health Reforms – The Continuing Saga

Revolving Doors: New Zealand's Health Reforms – The Continuing Saga

Robin Gauld (2009), Revolving Doors: New Zealand's Health Reforms – The Continuing Saga (Second Edition). Wellington: Health Services Research Centre and Institute of Policy Studies. £21.00, pp. 259, pbk.

Robin Gauld (2009), Revolving Doors: New Zealand's Health Reforms – The Continuing Saga (Second Edition). Wellington: Health Services Research Centre and Institute of Policy Studies. £21.00, pp. 259, pbk.

Implementing new modes of governance in the New Zealand health system: An empirical study

Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems. To understand the implementation of new modes and mechanisms of governance under New Zealand health reforms and to assess these in the context of international trends. Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N=144, 66% response rate), interviews with chairs (N=14) and chief executives (N=20), and interviews with national policy makers/officials (N=19) and non-government providers and local stakeholders (N=10). Data were collected over two time periods (2001/2002; 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance. Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implementation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly. The successful implementation of a mix of governance modes in New Zealand 2001-2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participation, and accountability to the centre enhanced through political rather than bureaucratic mechanisms.

General practice and the New Zealand health reforms – lessons for Australia?

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

The New Zealand health reforms: dividing the labour of care

This paper examines the concept of care as it was practised and conceptualised within one hospital group in southern New Zealand during the health reforms. The paper argues that these reforms brought about a division in the labour of care between the broad group of managers, computer analysts, administration officers, and the clinical staff. Aspects of these two empirically derived categories of care are elaborated, as well as the problems associated with each style. While this division in the labour of care is argued to be an unintended local consequence of the New Zealand health reforms, it also represents a more global phenomenon—the abstraction of social life.

Prioritizing patients for elective surgery: clinical judgement summarized by a Linear Analogue Scale.

The New Zealand health reforms have resulted in the requirement that surgeons utilize Clinical Priority Access Criteria (CPAC) to ration patient access to elective surgery. The validity of the tools used as CPAC has been challenged. An alter-native tool, the Linear Analogue Scale (LAS), is therefore used in our institution. Our objectives were to determine the variables that influence the priority score generated using the LAS, and the length of time waited by patients awaiting general surgical procedures. A cohort of 918 patients who were listed for elective general surgical procedures at Auckland Hospital, Auckland, New Zealand between 1 July 1998 and 31 March 1999 were studied. Patients were given a priority score generated using the LAS. For each patient, the time from assessment until his or her procedure was documented. Linear and logistic regression models were used to investigate variables (age, gender, diagnosis and surgical team) that influence priority score. Cox proportional hazards models were used to investigate variables (priority score, age, gender, and diagnosis) that influence the length of time waited. Graphical presentation showed a pattern of priority scores falling into 'bands' for different diagnoses. Diagnosis, and to a lesser extent surgical team, influenced priority score. Survival analysis showed 'time waited' to be influenced by priority score, diagnosis, and patient age and gender. The LAS may have a useful role in the difficult sphere of patient prioritization. Its strength lies in its simplicity. Further investigation of reliability and effect on patient outcomes is required.

Shared Governance within the market‐oriented health care system of New Zealand

The New Zealand health reforms, announced in 1991 and implemented over the 3-year period 1992-1994, were market-oriented, following a competitive model that had been applied across New Zealand's public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on-going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management. Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non-health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private. Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of 'the market' and 'humanity' This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the 'humanities'. It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced. This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross-organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.

Beyond New Zealand's Dual Health Reforms

The New Zealand health system was substantially reformed in 1993 with the introduction of a purchaser–provider split, competitive contracting and managerialism. The new system failed to deliver the desired gains and, in 1996, the reforms were “reformed”. While there has been widespread study of the 1993 reforms, there has been little discussion to date of the 1996 changes and the emerging directions for New Zealand health policy and service delivery, which remain unclear. This paper discusses the New Zealand health reforms of the 1990s. It briefly outlines the 1993 reforms and their results. Next, it details the 1996 “reforms”. Third, it discusses developments since 1996, some of which have emerged out of the 1993 reforms, but which have gathered momentum only since the 1996 changes were announced. In the conclusion, the paper lists some of the directions in which the New Zealand health sector appears to be heading, noting that there is a need for coordination of the sector, and for permanence.

The Labour Relations of New Zealand's Health Reforms

This paper examines factors contributing to the environment within which reform of New Zealnnd's public health care and its industrial relations system occurred. These include radical state sector; health and labour law reforms that marketised the health sector, decentralised bargaining, the ending of compulsory union membership and the elimination of the requirement that employers bargain 'in good faith'. The paper examines the implementation of these changes and their impact on various unions. Domestic service workers have fared poorly, while medical specialists have benefited from the reforms. The impact on nursing and support staff unions has varied according to regional and market pressures for different occupations. Various union strategies and structures are examined. The paper concludes that reform has ended the exceptionalism of labour relations in New Zealand.

New Zealand health reforms: Effect on ophthalmic practice

Are specialized ophthalmic units with inpatient facilities going to disappear in the New Zealand public health system? We have entered the era of cost containment, business methodologies, bench marking, day case surgery, and technologic advances. The dilemma for nursing is maintenance of a skill base with dwindling clinical practice areas.

Management of health system reform: a view of changes within New Zealand.

This paper reports on the context and process of health system reform in New Zealand. The study is based on interviews conducted with 31 managers from three Crown Health Enterprises (publicly funded hospital-based health care organizations). A number of countries with publicly funded health services (e.g., UK, Australia and New Zealand) have sought to shift from the traditional 'passive' health management style (using transactional management skills to balance historically-based expenditure budgets) to 'active' transformational leadership styles that reflect a stronger 'private sector' orientation (requiring active management of resources--including a return on 'capital' investment, identification of costs and returns on 'product lines', 'marketing' a 'product mix', reducing non-core activities and overhead costs, and a closer relationship with 'shareholders', suppliers and customers/clients). Evidence of activities and processes associated with transformational leadership are identified. Success of the New Zealand health reforms will be determined by the approach the new managers adopt to improve their organization's performance. Transformational leadership has been frequently linked to the successful implementation of significant organizational change in other settings (Kurz et al., 1988; Dunphy and Stace, 1990) but it is too early to assess whether this is applicable in a health care context.

A reforming accountability: GPs and health reform in New Zealand.

Over the last ten years or so, many countries have undertaken public sector reforms. As a result of these changes, accounting has come to play a more important role. However, many of the studies have only discussed the reforms at a conceptual level and have failed to study how the reforms have been implemented and operated in practice. Based on the work of Lipsky (1980) and Gorz (1989), it can be argued that those affected by the reforms have a strong incentive to subvert the reforms. This prediction is explored via a case study of general practitioner (GP) response to the New Zealand health reforms. The creation of Independent Practice Associations (IPAs) allowed the State to impose contractual-accountability and to cap their budget exposure for subsidies. From the GP's perspective, the IPAs absorbed the changes initiated by the State, and managed the contracting, accounting and budgetary administration responsibilities that were created. This allowed individual GPs to continue practising as before and provided some collective protection against the threat of state intrusion into GP autonomy. The creation of IPAs also provided a new way to manage the professional/financial tension, the contradiction between the professional motivation noted by Gorz (1989) and the need to earn a living.

LIMITS ON THE UTILIZATION OF ALTERNATIVE THERAPIES BY DOCTORS IN NEW ZEALAND: A PROBLEM OF BOUNDARY MAINTENANCE

This paper uses two case studies to examine the scope for medical practitioners to utilize alternative forms of diagnosis and treatment. The first is a specific study of a medical practitioner who was deemed to have transgressed the boundaries of orthodox medicine. The second is a general case study which examines the possible effects of a new medical practitioners bill and the New Zealand health reforms. It is suggested that when the medical profession is faced with external threats it attempts to strengthen itself at the cost of limiting the autonomy of its membership.

Editorial: Front-line pharmaceutical management in the New Zealand health reforms

Introduction The speed and scale of the New Zealand health reforms are unprecedented in health management. Four...

Defining core services: New Zealand experiences.

A key aspect of the New Zealand health reforms was the proposed development of an explicit core of services to which all New Zealanders would have access. A range of approaches has been taken by the government, its advisers, purchasers and providers to describe sets of services to which New Zealanders are to have access. The development of an explicit core aims to promote equity of access to services, to ensure that those services available are those that are the most cost-effective and the services New Zealanders feel to be the most important, and to clarify entitlements to publicly funded health care. This paper describes the current approaches that are being used to define core services in New Zealand, discusses the reasons behind some of the choices made and notes some key issues for further policy debate.

Core services and the New Zealand health reforms.

The last 5 years have seen dramatic changes in health care provision in New Zealand. Amidst considerable controversy, the 14 Area Health Boards were abolished in July 1993. The State now funds 4 Regional Health Authorities (still on the basis of a weighted population formula) from Vote Health (the health sector's share of public expenditure). The role of the National Advisory Committee on Core Health and Disability Support Services and other bodies in determining the annual policy and service obligations faced by the 4 Regional Health Authorities is discussed.

New Zealand's health reforms run into trouble

The new organisations set up last year to replace New Zealand's area health boards have lost $NZ47m (pounds sterling 17m) in their first three months of operation. Three of the 23 crown health enterprises made a profit of about $NZ1m (pounds sterling 370 000). About 94% of the enterprises' funding came from the four regional health authorities, while patient charges generated under 1% of their income. The figures should not come as a surprise, said …

Financial issues in health care, Pt II. The New Zealand health reforms.

Financial issues in health care, Pt II. The New Zealand health reforms.