Change through continuity:a quiet revolution in primary health care in New Zealand

Abstract

IN A RECENTLY PUBLISHED paper entitled Continuity through change: the rhetoric and reality of health reform in New Zealand, I and my co-authors Nick Mays and Nancy Devlin pointed out that, in spite of a series of major health sector reforms during the 1990s and early 2000s, some key aspects of the system have endured.1 Moreover, many incremental changes to existing processes and systems that occurred during the reform period have, arguably, been more important to improving the functioning and performance of the system than the more high level (and more visible) structural changes. Since that paper was written, many further changes have occurred in the organisation, funding and management of the New Zealand health system. However, in contrast to the 1990s, the focus now is on continuity and stability rather than on any need for further major change. Indeed, terms such as ?reform? or ?restructuring? have now all but vanished from any debate about health policy in New Zealand. Perhaps the reformers have learned that health system reform is akin to training for the Olympics. The whole process takes a fair bit of time and effort, and results are unlikely to be achieved in the short term. Further major reform is also not regarded as politically viable. As noted in an article in the New Zealand Herald just before the general election in September, there is ?. . . considerable public sensitivity over any whiff of restructuring in health?.2