A study of New Zealand’s District Health Board (DHB) reform between 2000 and 2022 found that despite policy intent, actors holding political power shaped health outcomes, curtailing mechanisms that could have made a significant impact on equitable health outcomes between population groups. The study used an exploratory case study methodology based on insights from key informant interviews. Attention to power and resource complements technical elements of health system reform, according to the study authors, by helping to understand where and how to intervene so that reforms achieve their desired goals.
For those of us who have held governance roles in DHBs, the authors confirm here the (unequal) power and resource distribution in our health system, with hospital care often dominating primary care. Although we now have a national board, these results offer useful information about shifting power to communities most affected by inequities, and the current government’s focus and investment in primary care.
Independent commentary by Dr. Matire Hardwood
Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.
Research Review publications are intended for New Zealand health professionals.
Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.
