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The Kiwi way: lessons from New Zealand

BMJ 1996; 312 doi: (Published 09 March 1996) Cite this as: BMJ 1996;312:645
  1. John Ovretveit

    New Zealand is proud of being the first country to create a universal social security system and free health care in the late 1930s. This reflects the strong socialist tradition of the country, which has been sustained by a scarcity of labour for most of its history. It was the socialist party that introduced deregulation and market reforms in the 1980s. Nationalised industries were privatised, but the health service was untouched until a conservative government introduced market type reforms in 1993. Reforms are modelled on the British system, with a purchaser and provider split, competition for income through contracts, but without primary care purchasing. The area health boards have been abolished and four purchasing regional health authorities set up with populations of around 800000 each. The changes generated much controversy, although it is arguable that the reforms only made more visible the many problems of the health care system that are similar to those faced by Britain.

    Two unpopular changes were abolishing political boards at area and hospital level and introducing charges for each day of stay in hospital. After a few months the hospital charges were dropped but there is still concern about the lack of local representation and accountability, especially in relation to the large purchasing organisations, which are viewed as remote from the people they are supposed to serve. Partly to make up for lack of local representation, purchasers and other public health …

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