JANUARY

NEW ZEALAND
by establishing more convenient locations for patients (outside of hospital settings) and by emphasizing chronic
disease management (Ryall, 2008; Ministerial Review Group, 2009). These centers provide comprehensive
primary care and care coordination, after-hours services, and some minor elective procedures for an enrolled
population. New facilities will see services and providers colocated, or coordination of services improved, with
funding from both primary care budgets and DHBs.
Patients enrolled in PHOs have a medical home, but PHOs vary widely in size, performance, and activities.
The highest-performing among them provide a model that, if nationally emulated, would result in all enrollees
having a fully functional, multidisciplinary medical home, although institutional barriers to integrating primary
and hospital care would remain.
The New Zealand government is accelerating the drive for clinical integration to create a more patient-centered
health system. It is also ensuring that all DHBs’ annual plans include proposals for integration. These directions
have been propelled by a new PHO contract in place since mid-2013 that requires PHO–DHB alliances modeled
after Integrated Family Health Center pilot programs. There is considerable scope for these alliances to
integrate health and social services (see below), and there is a gradual move toward pooled funding streams.
Some specialized providers contracted by the government that focus on vulnerable populations, such as Maori
and Pacific people, work to coordinate health and social services (e.g., Whanau Ora, described above).
What is the status of electronic health records?
New Zealand has one of the world’s highest rates of information technology (IT) use among primary care
physicians, with almost 100 percent uptake (Schoen et al., 2012). The government’s goal is universal electronic
access to a core set of residents’ personal health information by 2014. However, despite some progress, that
goal is unlikely to be met, owing to the complexity of implementing a national patient portal. Clinicians and
vendors are working together on numerous projects: there is a larger emphasis on supporting and enabling
integrated care, and a shift toward regional investment decisions and solutions. However, challenges with legacy
systems remain.
Increasingly, primary care IT systems provide services such as structured electronic transfer of patient records,
electronic referrals, decision support tools with patient safety features, and patient access to health information
in a secure environment.
In the near future, there will be more emphasis on facilitating secure sharing of patient information among
community, hospital, and specialist settings, including common clinical information; providing all consumers with
an online view of their information; and supporting the development of shared-care plans (in which a number
of health professionals are involved in a person’s care). However, current levels of interoperability are limited.
The National Health IT Board works with a number of sector groups and receives advice from, among others,
clinicians, consumers, and vendors. The Health Information Standards Organisation supports and promotes the
development and use of standards to ensure interoperability between systems. Every person who uses health
and disability support services has a unique national health number, facilitating the process of building
interoperable systems.
How are costs contained?
The financial sustainability of publicly funded health care is a top government priority. To support this goal,
government has implemented a range of measures, including four-year planning to align expenditure with
priorities over a longer period and improving regional collaboration to drive efficiencies. All new proposals must
be integral to a four-year plan and demonstrate their fit with the strategic direction of the health sector.
Cost control in DHBs has been closely monitored by the Ministry of Health, with a significant reduction in
deficits over the last five years, from NZD154.8 million (USD105.4 million) in 2008–2009 to NZD7.4 million
(USD5.0 million) in 2013–2014 (personal communication, Ministry of Health). These reductions are achieved
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