It’s really only the fourth of those critical areas – being health-system governance – that is the immediate object of the reforms. When we look at how the system is run, the scale of change is significant, but not enormous.
For scholars of health-policy reform, centralising or decentralising a health system is not particularly noteworthy, despite the disruptive and energising effects it can have on those caught up in the change.
What about the pace of change? In terms of speed, the reform vehicle is more a Mazda Demio than a Maserati.
Key elements of the changes, such as the introduction of localities, are to be phased in over three years. The effects on hospitals of the abolition of DHBs will also take a few years to emerge.
The Government’s pace is nothing like the “big bang” reforms of the 1990s, although it is worth remembering that those reforms eventually followed a much slower and meandering path than was intended.
How will these reforms register on the international health-policy landscape?
It’s the creation of Te Aka Whai Ora that international health policy experts are likely to take a keen interest in, particularly in other countries where indigenous peoples experience significant inequities.
I suspect introduction of localities will also attract international attention, but that will depend on progress in implementation.
One main takeaway from our analysis of health reform across 12 countries is that ambitious health-reform policies generally mutate into something much more incremental, and rarely meet their stated objectives.
This assessment certainly applies to past health reforms in New Zealand, such as those of the early 1990s and the Primary Health Care Strategy of 2001.
Attempts at health reform are still an important catalyst for improving a health system. Important changes take place that, when considered in retrospect, have their origins in policy reforms.
There are plenty of international examples of this phenomenon, but the two Aotearoa examples that stand out are the creation of Pharmac and the growth of Māori health providers in the 1990s.
Neither of these were part of the big-bang reform blueprint of the time. Most elements of that blueprint did not materialise. Yet those two important developments would not have happened without the catalyst of a reforming government.
In the world of health-system reform, therefore, shooting for the stars increases the chances of ending up on the moon.