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


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


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

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    References listed on IDEAS

    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.
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    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 & Nuti, Sabina, 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. repec:eee:socmed:v:199:y:2018:i:c:p:132-139 is not listed on IDEAS
    4. Toth, Federico, 2010. "Healthcare policies over the last 20 years: Reforms and counter-reforms," Health Policy, Elsevier, vol. 95(1), pages 82-89, April.
    5. 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.
    6. 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.
    7. repec:kap:jbuset:v:142:y:2017:i:4:d:10.1007_s10551-016-3041-x is not listed on IDEAS
    8. 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.
    9. repec:spr:chinre:v:9:y:2016:i:4:d:10.1007_s12187-015-9357-8 is not listed on IDEAS


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