New Zealand's experience with priority setting

In the late 1980s and early 1990s, many developed countries restructured their healthcare systems, in part to improve efficiency and address rising costs. In New Zealand, major reforms in 1992 resulted in a purchaser-provider split with a strong emphasis on contracting and regulated competition. The Core Services Committee, now the National Health Committee, was established to advise the minister of health on the health service's priorities.3 A key task of the committee was to advance public debate and understanding of limited healthcare resources and the need to ration services.

The committee proposed that prioritisation decisions should be explicit and transparent and based on four principles, which have underpinned much of its subsequent work: effectiveness, efficiency, equity, and acceptability.4 Drawing on this work, a number of regional and national funding agencies developed prioritisation processes and attempted to apply these to funding allocation decisions. In 1999, the national Health Funding Authority added the principle of Maori health to those of the National Health Committee when …