New Zealand Health System Review

Health Systems in Transition Vol. 4 No. 2 2014 New Zealand Health System Review Health Systems in Transition Vol. 4 No. 2 2014 New Zealand Health System Review Written by: Jacqueline Cumming, Victoria University of Wellington Janet McDonald, Victoria University of Wellington Colin Barr, Victoria University of Wellington Greg Martin, Victoria University of Wellington Zac Gerring, Victoria University of Wellington Jacob Daubé, Victoria University of Wellington Wellington, New Zealand Edited by: Christian Gericke, The Wesley Research Institute and University of Queensland, Brisbane, Australia i WHO Library Cataloguing in Publication Data New Zealand health system review (Health Systems in Transition, Vol.4 No. 2 2014) 1. Delivery of health care. 2. Health care economics and organization. 3. Health care reform. 4. Health systems plans – organization and administration. 5. New Zealand. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN: 978 92 9061 650 4 (NLM Classification: WA 950) © World Health Organization 2014 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. ii Contents Preface ................................................................................................................ viii Acknowledgements ............................................................................................. x List of abbreviations ........................................................................................... xi Abstract ................................................................................................................ xv Executive Summary .......................................................................................... xvi Introduction ..........................................................................................................xvi Organization and governance ...........................................................................xvi Financing ............................................................................................................xviii Physical and human resources ........................................................................xix Provision of services ............................................................................................xx Principal health reforms ...................................................................................xxi Assessment of the health system ..................................................................xxiii Conclusion .........................................................................................................xxiv Chapter 1: Introduction ....................................................................................... 1 Chapter summary ................................................................................................. 1 1.1 Geography and sociodemography.............................................................. 2 1.2 Economic context .......................................................................................... 5 1.3 Political context ............................................................................................. 8 1.4 Health status ............................................................................................... 10 Chapter 2: Organization and governance ...................................................... 16 Chapter summary ............................................................................................... 16 2.1 Overview of the health system.................................................................. 17 2.2 Historical background ................................................................................ 18 2.3 Organization ................................................................................................. 25 2.4 Decentralization and centralization......................................................... 42 2.5 Planning ....................................................................................................... 43 2.6 Intersectorality – health initiatives outside the health care sector ... 44 iii 2.7 Health information management............................................................. 45 2.8 Regulation .................................................................................................... 46 2.9 Patient empowerment ............................................................................... 54 Chapter 3: Financing ........................................................................................ 59 Chapter summary ............................................................................................... 59 3.1 Health expenditure ..................................................................................... 60 3.2 Sources of revenue and financial flows .................................................. 65 3.3 Overview of the statutory financing system ........................................... 67 3.4 Out-of-pocket payments ............................................................................ 76 3.5 Voluntary health insurance ....................................................................... 77 3.6 Other financing ............................................................................................ 81 3.7 Payment mechanisms ............................................................................... 82 Chapter 4: Physical and human resources ................................................... 86 Chapter summary ............................................................................................... 86 4.1 Physical resources ..................................................................................... 87 4.2 Human resources ....................................................................................... 93 Chapter 5: Provision of services ...................................................................106 Chapter summary ............................................................................................. 106 5.1 Public health .............................................................................................. 107 5.2 Patient pathways ....................................................................................... 116 5.3 Primary/ambulatory care ........................................................................ 117 5.4 Specialized ambulatory care/inpatient care ........................................ 123 5.5 Emergency care ........................................................................................ 130 5.6 Pharmaceutical care ................................................................................ 132 5.7 Rehabilitation/intermediate care ........................................................... 136 5.8 Long-term care ......................................................................................... 137 5.9 Services for informal carers ................................................................... 141 5.10 Palliative care ............................................................................................ 142 5.11 Mental health care .................................................................................... 143 5.12 Dental care ................................................................................................. 146 5.13 Complementary and alternative medicine ........................................... 149 5.14 Health services for specific populations ..............................................

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