The New Zealand government has announced radical changes to its health system, including abolishing 20 district health boards in favour of a single national body similar to Britain’s National Health Service. The government is also establishing a national body for indigenous healthcare in an attempt to improve enduring racial inequities in the system.
The changes, announced by the health minister, Andrew Little, on Wednesday morning, will reshape the country’s health system, which has been under stress for some time.
When the Jacinda Ardern-led Labour government came into power it commissioned a system-wide review. It found major racial inequities, chronic under-resourcing and variable quality of care across categories, including mental health and disability. The health system has been known by citizens as the “postcode lottery”, as access to care can depend on which district health board they fall under.
“For the first time, we will have a truly national health system, and the kind of treatment people get will no longer be determined by where they live,” Little said.
Rather than 20 independent district health boards, a new entity, Health New Zealand, will run hospitals, primary and community health services. It will have four regional divisions. Little said the current system was “far too complicated for a small nation. We simply do not need 20 different sets of decision-makers … It leads to duplication, variability and inefficiency.”
The coronavirus pandemic has also highlighted problems in the current structure. While New Zealand’s response to Covid-19 has been lauded internationally, there were fears in-country that the fragmented health system and its accompanying bureaucracy might impede the rollout of mass testing, mass vaccinations or distributing resources to care for Covid patients.
The new national agency and public health units would act “as a joined-up national service, so we are better equipped to fight future outbreaks and pandemics”, said the associate health minister, Ayesha Verrall.
The development of the Māori Health Authority also marks a significant shift. New Zealand has long been plagued with chronic inequities in its health system – especially between Māori, the indigenous people who make up about 16% of the population, and other ethnic groups. In 2019 a government-commissioned Whānau Ora review concluded that “Māori health is in a humanitarian crisis”, with statistics showing significantly worse outcomes for Māori across all major measures, that Māori received less competent care, and were around twice as likely to encounter racial discrimination.
On Monday those disparities were brought home again: a study found that a young Māori person hospitalised for a major trauma was three times more likely to die than young people of other ethnicities suffering the same injuries.
“Māori health has suffered under the current system for too long,” said the associate health minister for Māori health, Peeni Henare. The new Māori Health Authority will be independent, with “joint decision-making rights”, as well as spending power to commission its own services where needed.
“The system has never allowed Māori meaningful control over issues affecting their own communities and has never really acknowledged that what we are doing isn’t working for Māori, and that by giving more control over to Māori communities, we might actually change things for the better,” Little said.
The changes will also refocus the healthcare system on prevention and “primary care” – the early, non-emergency encounters people have with the health system. That shift toward public health and prevention comes as illnesses like diabetes, heart disease and cancer account for an increasing portion of the country’s healthcare spend.
The moves have been welcomed by a number of experts. “I applaud the government for their courage in planning such profound changes,” said Assoc Prof Jacquie Kidd, of AUT Universit. “If fully realised, [The Māori Health Authority] will address the pervasive health disparities experienced by Māori,” she said.
Prof Robin Gauld, director of the centre for health systems and technology at Otago University, said the changes were “a bold series of steps and in general very positive”.
While the district system had been designed to bring in public and local voices, he said, it had major problems – including the “postcode lottery” and a lack of healthcare experience on boards. “Healthcare is tremendously complex – if you put in place people who might have some experience in community service or governance, but put them into healthcare without much prior knowledge of how it all functions, it’s a recipe for failure,” he said. Gauld said the Māori Health Authority was also “very exciting and very positive”.
“It’s been a long, long time coming,” he said.
While he generally applauded the changes, Gauld said they would not resolve all the inequities created by New Zealand’s coexisting public and private healthcare systems.
Those who were wealthy or had private health insurance had access to some procedures that others either could not access, or faced lengthy wait times for, he said: “Imagine if police worked that way – ‘Oh, you’re being robbed? We can be there in a few minutes if you pay us $5,000, otherwise, we’ll be an hour.’ There are deep-seated issues of justice that sit behind that.”
The structural changes announced on Wednesday did not include new funding for healthcare. Announcements of health spending allocations are expected at the government’s budget release next month. The reforms are expected to take three years to complete.
The opposition National party called the changes “reckless”. Its health spokesperson, Shane Reti, criticised the creation of the Māori Health Authority, and said his party would repeal it when back in power. “On one hand health minister Andrew Little claims he’s trying to create a single, harmonious, joined-up health system and on the other he’s creating a two-tiered funding system based on race,” Reti said.
He said centralising the health system would mean regions “lose their voice and their autonomy”, and it could create more bureaucracy.