Intended for healthcare professionals

Education And Debate

Experience with rationing health care in New Zealand

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1346
  1. Colin M Feek, Chief medical adviser (,
  2. Winston McKean, Project managerb,
  3. Loek Henneveld, Chief medical adviserc,
  4. Graeme Barrow, Editord,
  5. Wendy Edgar, Programme directore,
  6. Ron J Paterson, senior lecturer in lawf
  1. aMinistry of Health, PO Box 503, Wellington, New Zealand
  2. bClinical Training Agency, PO Box 588, Christchurch, New Zealand
  3. cWhangarei Area Hospital, Northland Health, PO Box 742, Whangarei, New Zealand
  4. dNorthern Advocate, New Zealand PO Box 210 Whangarei, New Zealand
  5. eNational Health Committee Secretariat, Ministry of Health, PO Box 5013, Wellington New Zealand
  6. fUniversity of Auckland, Law School, Private Bag 92019, Auckland, New Zealand
  1. Correspondence to: Dr Feek Colin

This paper was presented at the second international conference on priorities in health care in London, 8-10 October 1998

New Zealand's health reforms were introduced in 1993 and changed the framework for health service delivery; this framework clearly contemplates rationing. We describe the development of guidelines for entry into end stage renal failure programmes in the northern region of New Zealand,1 how they were used in the clinical decision making process, and how they influenced public opinion. In particular, we describe two cases which put the decision to ration renal dialysis under the public spotlight.

Summary points

New Zealand's health reforms contemplate rationing of services

Clinical guidelines were preferred to determine access to services rather than a simple list

The development of guidelines for access to end stage renal failure programmes tested the expectations of the public, patients, politicians and clinicians

Public opinion is gradually shifting to accept that rationing of health care is inevitable

Rationing in New Zealand

The Health and Disability Services Act was introduced in New Zealand in 1993. The purpose of the act was to reform the public funding and provision of health services and disability services in order to secure the best health; the best care or support for those in need of those services; and the greatest independence for people with disabilities that is reasonably achievable within the available funding.

The National Advisory Committee on Core Health and Disability Support Services (core services committee) was appointed under the act to advise the minister on “the kinds, and relative priorities, of public health services, personal health services, and disability services that should, in the committee's opinion, be publicly funded.”

The committee was established in March 1992, but by October 1994 its third report to government had rejected the use of a simple list to define the services to which New …

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