Back to the Future? Reflections on past reforms and future prospects for health services in New Zealand |
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Authors: | Ross Barnett Pauline Barnett |
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Institution: | (1) Department of Geography, University of Canterbury, Private Bag 4800, Christchurch, New Zealand;(2) Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand |
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Abstract: | In 1991 the New Zealand health system began to experience what has been termed the `turbulent decade'. Without health sector
consultation or public mandate, an era of imposed market oriented reforms began. These changed the overall culture of health
care delivery and the expectations of New Zealanders regarding the role of the state in the provision of welfare. In retrospect
the ideologically driven imposition of the market-oriented reforms was not an exercise of bold leadership but one of political
arrogance and rejection of established community values. Within the community, the neoliberal experiment heightened income
and health inequalities, created a loss of social cohesion and generally provoked feelings of powerlessness. In the health
sector, the reforms polarised clinical and commercial cultures and changed the geography of health care delivery. This occurred
not only because place was de-emphasised, but also because decentralisation of purchasing created four health systems with
widely divergent contracting arrangements and standards of care. The lessons of the health reforms have been painful, and
must not be lost. A fundamental lesson is that market approaches to the delivery of health care have major limitations and
that the ultimate goal of a health system should be the equitable, effective and efficient provision of care, not the profitable
sale of commodities. Since 1997 there has been a retreat from the market, although it is not clear whether recent policy developments
represent a new or distinctive `third way' or a pragmatic `pick and mix', combining the best from the market and the managerialism
first introduced by Labour in the 1980s. Quite clearly, the experiment with the market was not sustainable. Whether this will
also be true of the more recent and pragmatic `pick and mix' approach of the `third way' to health care reform is uncertain.
This revised version was published online in July 2006 with corrections to the Cover Date. |
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Keywords: | health sector restructuring neoliberalism New Zealand `Third Way' |
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