Public health and the reforms: the New Zealand experience. 1994

D Bandaranayake
Department of Public Health, Wellington School of Medicine, Wellington South, New Zealand.

The main aim of a national public health service is to conserve and improve the population's health. The health service reforms introduced in 1992 proposed the establishment of a Public Health Commission, which was to be responsible for health monitoring, public health policy advice and the purchase of public health services. These reforms, implemented in 1993, while emphasising a purchaser-provider separation also earmarked a budget for public health activities to be administered by the Commission. Such protection of funding is unusual. Public health activities span a wide range of measures to protect and promote health as well as to prevent disease. Many of these measures have been, and will continue to be, carried out at a local level. The results of some of these measures are not usually seen in the short term. Improvement of the population's health also requires proactive measures which are outside the traditional health service. The demonstration of quantifiable benefits to the public's health from such measures may require an even longer term. It is mainly in this area of activity, however, that the achievements of the Commission will be judged. Beginning with a short summary of the history of public health services in New Zealand, this paper looks briefly at the events that led to the establishment of the Public Health Commission, before moving on to describe its achievements to date, the challenges it faces and its impact on public health service provision. Based on such observations and an analysis of the strengths and weaknesses of the Commission, the paper attempts an appraisal of the public health function in the reformed health service, a function that will almost certainly be observed with interest in other countries. Certain ways of improving the public health function are outlined in the conclusions.

UI MeSH Term Description Entries
D009520 New Zealand A group of islands in the southwest Pacific. Its capital is Wellington. It was discovered by the Dutch explorer Abel Tasman in 1642 and circumnavigated by Cook in 1769. Colonized in 1840 by the New Zealand Company, it became a British crown colony in 1840 until 1907 when colonial status was terminated. New Zealand is a partly anglicized form of the original Dutch name Nieuw Zeeland, new sea land, possibly with reference to the Dutch province of Zeeland. (From Webster's New Geographical Dictionary, 1988, p842 & Room, Brewer's Dictionary of Names, 1992, p378)
D011635 Public Health Administration Management of public health organizations or agencies. Administration, Public Health
D017146 Models, Organizational Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups. Organizational Models,Model, Organizational,Organizational Model
D049673 History, 20th Century Time period from 1901 through 2000 of the common era. 20th Century History,20th Cent. History (Medicine),20th Cent. History of Medicine,20th Cent. Medicine,Historical Events, 20th Century,History of Medicine, 20th Cent.,History, Twentieth Century,Medical History, 20th Cent.,Medicine, 20th Cent.,20th Cent. Histories (Medicine),20th Century Histories,Cent. Histories, 20th (Medicine),Cent. History, 20th (Medicine),Century Histories, 20th,Century Histories, Twentieth,Century History, 20th,Century History, Twentieth,Histories, 20th Cent. (Medicine),Histories, 20th Century,Histories, Twentieth Century,History, 20th Cent. (Medicine),Twentieth Century Histories,Twentieth Century History
D018166 Health Care Reform Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services. Healthcare Reform,Health Care Reforms,Healthcare Reforms,Reform, Health Care,Reform, Healthcare,Reforms, Health Care,Reforms, Healthcare

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