JANUARY

NEW ZEALAND
management (e.g., cleaning), which accounts for less than one-third of home support funding, is income-tested.
Personal care (e.g., showering) is provided free of charge. Home care services are all provided by
nongovernment agencies.
What are the key entities for health system governance?
As the health system is primarily public, government-funded and -appointed entities dominate governance
structures. Some, like the health and disability commissioner (whose function is to champion consumers’ rights
in the health sector), sit at arm’s length from the central government. Others are “crown entities,” with their own
boards, and are required to follow government policy through letters of expectation. Key national
arrangements, all of which have a role in providing information to, and engaging with, the public, are:
• the Ministry of Health, which has overall responsibility for the health and disability system. The ministry acts
as the Minister of Health’s principal advisor on health policy and maintains a role as funder, monitor,
purchaser, and regulator of health and disability services. While it sets capitation rates paid to GPs, it has
no role in regulating patient copayments.
• the National Health Board (NHB), which aims to improve the quality, safety, and sustainability of health care
by actively engaging with clinicians and the wider health sector. The NHB provides advice to the health
minister and the director-general of health on all of the aforementioned matters. It has two subcommittees:
the Capital Investment Committee, which provides advice on matters relating to capital investment and
infrastructure in the public health sector, in line with the government’s service planning direction; and
the National Health IT Board, which provides advice on the implementation and use of IT systems across
the sector.
• NZ Health Partnerships, established in July 2015 to support DHBs in delivering shared services and reduce
costs by identifying opportunities for savings in administrative, support, and procurement.
• the Pharmaceutical Management Agency of New Zealand, which assesses the effectiveness of drugs,
distributes prescribing guidelines, and determines inclusion of drugs on the national formulary (with relative
cost-effectiveness being one of nine criteria for inclusion). In addition, certain medical devices have been
added to its schedule (Gauld, 2014). As of late 2015, a new set of “factors for consideration” will be used
to underpin decisions: need; health benefit; costs and savings; and suitability.
• the Health Quality and Safety Commission, which ensures that New Zealanders receive the best health and
disability care possible given available resources. It is also working toward what is known as the New
Zealand “triple aim”—improved quality, safety, and experience of care; improved health and equity for all
populations; and better value for public health system resources.
• the National Health Committee (NHC), which advises government on priorities for new and existing health
technologies. All new diagnostic and nonpharmaceutical treatment services and significant expansions
of existing services are referred to the NHC for evaluation and advice. The committee also provides advice
on what technologies are obsolete or no longer provide value for money.
What are the major strategies to ensure quality of care?
The aforementioned health and disability commissioner investigates patient complaints, reports directly
to Parliament, and has been active in promoting quality and patient safety.
DHBs are held formally accountable to government for delivering efficient, high-quality care in hospitals,
as measured by the achievement of targets across a range of indicators. These include six “health targets,”
published quarterly, that aim to stimulate competition among DHBs and are enforced by financial sanctions
if not met. In addition, DHB performance with regard to waiting times, access to primary care, and mental
health outcomes is publicly disclosed. Also publicly reported are data comparing the performance of PHOs,
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The Commonwealth Fund