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
The Electoral System Reform of New Zealand: Its Process, Consequences, and Implications
