IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v61y2005i2p253-262.html
   My bibliography  Save this article

Continuity through change: The rhetoric and reality of health reform in New Zealand

Author

Listed:
  • Ashton, Toni
  • Mays, Nicholas
  • Devlin, Nancy

Abstract

New Zealand, like most other developed economies, has struggled to establish the best way of organising and delivering publicly financed health care services. Before the 1990s, hospitals and some related services were planned and provided by regionally based, locally elected health boards. This system was replaced in 1993 with a quasi-market structure in which separate organisations were responsible for the purchasing and provision of services. This in turn was replaced in 2001 by a system of locally elected boards that is remarkably similar to that which existed in the 1980s. The change to and subsequent abandonment of the quasi-market structure implies major changes to the way that health services are organised in New Zealand and suggests policy U-turns in (at least) three key areas: from cooperation to competition (and back); from integration of the roles of purchaser and provider to contractual arrangements (and back); and from local decision-making to centralised decision-making (and back). The aims of this paper are to examine the depth of system change in practice and to consider the extent to which the stated goals of reformers have disguised the degree of continuity between reform eras. We conclude that simplistic distinctions between structural approaches often fail to capture salient influences upon decision-making. New Zealand has not, in fact, been "to market and back" as the rhetoric would have us believe. Key aspects of the health system have endured throughout the reform period and these arguably have more importance for system functioning and performance than the high-level structural changes.

Suggested Citation

  • Ashton, Toni & Mays, Nicholas & Devlin, Nancy, 2005. "Continuity through change: The rhetoric and reality of health reform in New Zealand," Social Science & Medicine, Elsevier, vol. 61(2), pages 253-262, July.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:2:p:253-262
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(04)00348-X
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Toni Ashton & David Press, 1997. "Market Concentration in Secondary Health Services Under a Purchaser-Provider Split: The New Zealand Experience," Health Economics, John Wiley & Sons, Ltd., vol. 6(1), pages 43-56.
    2. Ashton, Toni & Cumming, Jacqueline & McLean, Janet, 2004. "Contracting for health services in a public health system: the New Zealand experience," Health Policy, Elsevier, vol. 69(1), pages 21-31, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Cookson, Richard & Laudicella, Mauro & Donni, Paolo Li, 2013. "Does hospital competition harm equity? Evidence from the English National Health Service," Journal of Health Economics, Elsevier, vol. 32(2), pages 410-422.
    2. Bevan, Gwyn & Evans, Alice, 2018. "Reputations count: why benchmarking performance is improving health care across the world," LSE Research Online Documents on Economics 86469, London School of Economics and Political Science, LSE Library.
    3. Toth, Federico, 2010. "Healthcare policies over the last 20 years: Reforms and counter-reforms," Health Policy, Elsevier, vol. 95(1), pages 82-89, April.
    4. Ellen A. Stewart & Scott L. Greer & Iain Wilson & Peter D. Donnelly, 2016. "Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(2), pages 69-85, April.
    5. Gauld, Robin, 2012. "New Zealand's post-2008 health system reforms: Toward re-centralization of organizational arrangements," Health Policy, Elsevier, vol. 106(2), pages 110-113.
    6. repec:kap:jbuset:v:142:y:2017:i:4:d:10.1007_s10551-016-3041-x is not listed on IDEAS
    7. Petsoulas, Christina & Allen, Pauline & Hughes, David & Vincent-Jones, Peter & Roberts, Jennifer, 2011. "The use of standard contracts in the English National Health Service: A case study analysis," Social Science & Medicine, Elsevier, vol. 73(2), pages 185-192, July.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:61:y:2005:i:2:p:253-262. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.