These researchers discuss the history of New Zealand’s health system, which was originally established as a universal, tax-funded national health service. They go on to describe how this universal orientation and strong commitment to social service delivery has contributed to favourable health statistics in this country and the establishment of unique institutions that have arisen in response to the needs of New Zealanders. These include innovative Māori services, a no-fault accident compensation scheme, and the Pharmaceutical Management Agency (PHARMAC), which negotiates with pharmaceutical companies to provide funded access to medicines purchased using public money. Nevertheless, the system is marred by persisting problems with access to care and an inability to deliver the promise of equitable health outcomes for all population groups. Structural changes during the 1990s have failed to deliver the expected efficiency gains and the system’s prioritisation of individual-level secondary services and performance targets have obscured the focus that is needed to address issues such as suicide, obesity, and poverty-related diseases through community-based health promotion, preventive activities, and primary care. The researchers reflect upon what changes are needed in order to strengthen the culture and capacity of the system and thereby achieve equity of access and outcomes for all population groups. In particular, the researchers suggest that the healthcare system expands the provision of Māori health services, integrates existing services and structures with new ones, aligns resources with need to achieve pro-equity outcomes, and strengthens population-based approaches to better deal with contemporary drivers of health status.
