New Zealand health care financing 'reforms' perceived ideological context

Policy-induced changes in Maori mortality patterns in the New Zealand economic reform period

New Zealand's pro-market reform process commencing in 1984, while generally popular, did not represent a net social benefit for all socio-economic, cultural and ethnic groups. The reforms imposed hardships on groups heavily dependent on manual jobs in the manufacturing sector, on groups experiencing above average rates of unemployment, and on groups dependent on social programmes for stability in income flows. One group possessing all three characteristics, and adversely affected, was New Zealand's aboriginal population--the Maori. Previous statistical analyses have established that the Maori are a low income group that suffered a substantial decline in relative income from 1984 to 1987. The statistical research in this study establishes that Maori aged 30-79 years also experienced an increase in mortality ratios relative to the rest of the population, commencing in 1987. It is postulated that the decline in economic stability was a source of stress for middle-aged Maori, and that this was a contributing factor to the increase in observed relative mortality.

New Zealand policy strategies concerning the funding of general practitioner care

The evolution of New Zealand health policy concerning general practitioner care suggests six major goals: (1) providing GP services universally at zero or very low user charges, (2) increasing the proportion of GPs in rural and sparsely populated areas, (3) increasing the proportion of primary care going to low-income populations, (4) increasing the effectiveness of primary care in promoting health, (5) lowering the cost of primary care provision, and (6) giving patient-consumers (with particular emphasis on Maori) more control over the environments in which primary services are provided. Policy packages have lacked analytical coherence, however, with the consequence that only some of the goals have been effectively promoted at any point in time. The particular policies promoted have varied over time depending on the political party in power, and on the international climate of opinion concerning the prioritising of goals. The current view is that the most significant shift in New Zealand health policy orientation occurred during 1992-1994, with the emphasis on managed competition strategies and increased reliance on user charges. The 1992-1994 policy reforms also reflect a long-standing orientation in New Zealand of attempting to separate the care of the poor from that of everyone else, and of providing care for the poor by the state in a paternalistic context, and the care for the non-poor in market arrangements that reflect the preferences of patients.