Decentralizing resource allocation: early experiences with district health boards in New Zealand

Journal of Health Services Research & Policy
T AshtonPauline Barnett

Abstract

In New Zealand in 2001, a system of purchasing health services by a centralized purchasing agency was replaced by 21 district health boards (DHBs) which are responsible for both providing health services directly and for purchasing services from non-government providers. This paper describes the processes associated with the allocation of health resources in the decentralized system and considers the extent to which four of the government's stated objectives are likely to be achieved. Two rounds of interviews with national stakeholders and senior DHB personnel plus case studies in five districts which included key informant interviews, observation at board meetings and document analysis. The re-structuring of the health sector in New Zealand appears to have simultaneously enhanced and inhibited the achievement of government objectives. Local decision-making has encouraged greater local responsiveness and new funding arrangements have allayed concerns about inter-regional equity. The system is less commercially oriented than it was during the 1990s and collaboration between DHBs is improving. However, the combination of increased integration of purchasing and provision within DHBs and the focus on financial deficits in the early...Continue Reading

References

Jun 28, 1997·BMJ : British Medical Journal·C Ham
May 12, 2001·BMJ : British Medical Journal·N DevlinN Mays
Aug 14, 2001·The International Journal of Health Planning and Management·P BarnettM Powell
Sep 17, 2002·Social Science & Medicine·Petra Riemer-Hommel
May 17, 2005·Social Science & Medicine·Toni AshtonNancy Devlin

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Citations

Sep 21, 2011·BMC Health Services Research·Roshan Perera, Helen J Moriarty
Jan 23, 2008·International Journal for Equity in Health·Lindsay M Sabik, Reidar K Lie
Feb 4, 2011·Policy, Politics & Nursing Practice·Jennifer B CarryerDenise Wilson

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