Editorials

Reforming the New Zealand health reforms

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7098.1844 (Published 28 June 1997) Cite this as: BMJ 1997;314:1844

Big bang gives way to incrementalism as competition is abandoned

  1. Chris Ham, Directora
  1. a Health Services Management Centre, University of Birmingham B15 2RT

    In common with several other countries, New Zealand has embarked on a far reaching programme of market oriented reforms in recent years. These reforms involved separating purchaser and provider responsibilities and using contracts and competition in an attempt to increase efficiency and enhance services' responsiveness. The former National government used its parliamentary majority to push these changes through quickly, starting in 1993. The big bang that resulted sent out a series of shock waves, and the effects continue to be felt.

    As Hornblow notes in this week's BMJ (p 1892),1 although the reforms have brought some benefits, overall they have failed to produce the improvements in performance that were anticipated. Furthermore, there have been several adverse consequences that have provoked opposition to the direction of change. Notwithstanding the argument that over a longer period the reforms might have worked as intended,2 steps have been taken to address the problems that have arisen and to put in place new policies.

    The election of a coalition government last autumn, bringing together the National party and New Zealand First, has already resulted in a commitment to abandon competition in favour of collaboration. The new government's statement on health policy …

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