Trans-Tasman health policy lessons | |
Health and Public Policy in New Zealand. Peter Davis, Toni Ashton (editors). Auckland: Oxford University Press, 2001 (x + 287 pp). ISBN 0 19 558417 1. |
As someone who arrived in New Zealand from Britain in 1987 and joined the Ministry of Health in 1994, I am keenly interested in research into the reform of New Zealand's public health system.
This book discusses key changes in health policy in recent years. It aims to enhance understanding of the process of health policy; to advance academic understanding by analysing in detail recent developments in key policy areas; and to see what lessons can be learned from New Zealand's experiences. It also attempts to draw some conclusions which might guide health policy-making in the future. The authors and contributors are all distinguished academics, but, as in many collaborative works, there is repetition. The book loses coherence and sometimes fails to draw together a conclusion. It does, however, provide insight into health reforms in New Zealand. The centrepiece of the book is the neo-liberal model of policy reform that underpins the changes in New Zealand from 1984 onwards. This theory of economics is placed in an international context and then the book describes how these changes were implemented in the New Zealand political climate. As Miriam Laugesen notes in her chapter, "...while the economic causes of healthcare reform are relatively similar cross nationally, the political fate of solutions to these causes shares more variation and outcome". She goes on to say that "despite the relatively strong leverage available to Cabinet in NZ between 1991 and 1996, the government struggled to apply its original plan of fundamental health sector change in New Zealand". The medical profession, and particularly the Coalition for Public Health, were strongly opposed to and alienated by these reforms, and their careful campaigning reduced public confidence in New Zealand's healthcare system. However, subsequent surveys have shown that patients remained satisfied while the public did not. If the reforms dented public confidence they also had significant effect on reducing hospital morale. The book fails to analyse the important role of the National Advisory Committee on Health Services (particularly its views of fairness of access to services). The health reforms did increase Maori involvement at all levels of the health sector. Policy analysis and formulation, governance of the boards of newly formed providers, hands-on service delivery by these new providers and consumer advocacy services for Maori, by Maori are certainly a result of the reforms. I think the book's conclusions are disappointing. One of the major lessons to be learned if you wish to reform the health system is that you must gain the acceptance of health professionals, who will maintain the confidence of the public. Despite these criticisms the book is readable and should sit on the shelf of anybody interested in health and public policy.
Colin Feek
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