Health

Description

Background and history

274. New Zealand’s health and disability system provides a number of health-related services, and features a mix of public and private ownership and funding that has increased in complexity over time.

275. The government element of the health system has evolved from Area Health Boards in the 1980s (which had bulk funding of hospitals and other services in one entity) through the Crown Health Enterprises/Hospital and Health Services and Regional Health Authorities/Health Funding Agency of the 1990s (where hospitals were set up along business lines and Authorities were purchasers of services) to the current District Health Boards (where hospitals are integrated into a funding body), established in the early 2000s. The main area of interest for government asset management today is the 21 District Health Boards (DHBs), which manage assets with a net book value of $3.8 billion.[74] Note that the replacement cost is higher than this (and is used in the regional breakdown shown in the diagram below).

Assets

Source: The Ministry of Health

276. Taken together, the current asset base is highly varied in age, quality, and fitness-for-purpose due to the patchwork nature of past asset planning and changing standards (e.g., seismic) and service requirements.

Institutional arrangements

277. There are a large number of organisations that make up New Zealand’s health and disability system (for example, rest homes, general practices, private hospitals, labs, imaging, Maori and Pacific providers), some with substantial assets, especially when considered cumulatively. The following diagram provides an overview of the structure of New Zealand’s health and disability system.[75]

Structure of the New Zealand health and disability system

Source: The New Zealand Health and Disability System: Organisations and Responsibilities - Briefing to the Minister of Health, November 2008[76]

278. DHBs plan, manage, provide and purchase services for the population of their district. This includes funding for primary care, public health services, aged care services and services provided by other non-governmental health providers, including Māori and Pacific providers.