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NEW ZEALAND largely through efficiency gains and cuts in spending on staff, services, and equipment. As public hospitals are essentially free of charge, there is no mechanism to shift costs to patients. There have been experiments with shared-savings arrangements in the past, with contracted providers such as GP networks. The National Health Committee prioritizes health technologies and provides advice as to which technologies no longer offer value for money, increasingly using comparative-effectiveness research in evaluation. The Pharmaceutical Management Agency uses mechanisms such as reference pricing and tendering to set prices for publicly subsidized drugs dispensed through community pharmacies and hospitals (Gauld, 2014). If patients prefer unsubsidized medicines (and if there are no clinical indications that these would be more effective), they pay the full cost. Such strategies have helped to drive down pharmaceutical costs and to keep drug expenditure per capita the fourth-lowest in the OECD in 2012 (OECD, 2014). What major innovations and reforms have been introduced? Reforms over the past two years have been mostly adjustments to existing arrangements, with one standout. In mid-2013, a new national Primary Health Organisation contract was issued, with new minimum PHO standards and a requirement that DHBs and PHOs enter into alliances. The rationale for the requirement was to link together the parts of the health system—GPs and public hospitals in particular—that operate largely separately but with common populations in a region. The impetus for forming these alliances is the government’s increasing concern over chronic disease and care for complex patients, and its desire to better support patients and their providers in primary care settings. These alliances reflect an important shift in the governance model and structures for designing and delivering health services in New Zealand. Each alliance must take a whole-system approach, bringing together clinical leaders, managers, and community representatives from across the local health system to consider health services from a patient perspective. An alliance’s focus is primarily integration, with the alliance setting service priorities, generating consensus on how those priorities will be met, and then sharing financial and other resources to facilitate implementation. Many alliances are creating further clinically led “service level alliances” targeting different areas of care design; many also govern health pathway development, which is rapidly expanding across New Zealand (Gauld, 2014b). The author would like to acknowledge the New Zealand Ministry of Health for its comments and for providing updated information for this profile. 130 The Commonwealth Fund
References NEW ZEALAND Gauld, R. (2013). “Questions About New Zealand’s Health System in 2013, Its 75th Anniversary Year.” New Zealand Medical Journal 126(1380):1–7. Gauld, R. (2014). “Ahead of Its Time? Reflecting on New Zealand’s PHARMAC Following Its 20th Anniversary.” Pharmacoeconomics 32:937–42. Gauld, R. (2014b). “What Should Governance for Integrated Care Look Like? New Zealand’s Alliances Provide Some Pointers.” Medical Journal of Australia 201(3):s67–s68. Ministerial Review Group (2009). “Meeting the Challenge: Enhancing Sustainability and the Patient and Consumer Experience within the Current Legislative Framework for Health and Disability Services in New Zealand.” Wellington: Ministry of Health. Ministry of Health (2013). Annual Report for the Year Ended 30 June 2013, Including the Director-General of Health’s Annual Report on the State of Public Health. Wellington: Ministry of Health. Organisation for Economic Co-operation and Development (OECD) (2015). OECD Health Statistics 2015. Organisation for Economic Co-operation and Development (OECD) (2015b). OECD.Stat. DOI: 10.1787/data-00285-en. Accessed July 2, 2015. Organisation for Economic Co-operation and Development (OECD) (2014). OECD Health Statistics 2014. Ryall, T. (2008). “Better, Sooner, More Convenient: Health Discussion Paper by Hon. Tony Ryall MP.” Wellington: National Party. Schoen, C. et al. (2012). “A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas.” Health Affairs 31(12):2805–16. International Profiles of Health Care Systems, 2015 131
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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Table 1. Health Care System Financi
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Table 3. Selected Health System Per
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The Australian Health Care System,
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AUSTRALIA low-income adults, childr
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What is being done to reduce dispar
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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CHINA is not substantially more exp
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CHINA Organization of the Health Sy
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CHINA References Chen, X. (2014).
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DENMARK In addition, nearly 1.5 mil
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DENMARK Social psychiatry and care
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DENMARK Quality data for a number o
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DENMARK portion is small, it makes
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ENGLAND immunization, and vaccinati
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ENGLAND Hospitals: Publicly owned h
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ENGLAND Organization of the Health
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ENGLAND How are costs contained? Ra
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ENGLAND Organisation for Economic C
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FRANCE VHI finances 13.8 percent of
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FRANCE The average income of primar
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FRANCE What are the key entities fo
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FRANCE inequities in prevention rel
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FRANCE Nolte, E., C. Knai, and M. M
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GERMANY There were 42 substitutive
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GERMANY The 16 state governments de
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GERMANY management system, by the s
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GERMANY What major innovations and
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INDIA Private health insurance: The
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Page 98 and 99: ITALY during hospitalization (Thoms
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Page 134 and 135: NORWAY Primary, preventive, and nur
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Page 144 and 145: SINGAPORE Medifund is the governmen
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The COMMONWEALTH FUND Affordable, q
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