Implementing new modes of governance in the New Zealand health system: an empirical study

Abstract

Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems. Objective: To understand the implementation of new modes and mechanisms of governance under New Zealand health reforms and to assess these in the context of international trends. Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N = 144, 66% response rate), interviews with chairs (N = 14) and chief executives (N = 20), and interviews with national policy makers/officials (N = 19) and non-government providers and local stakeholders (N = 10). Data were collected over two time periods (2001/2002; 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance. Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implementation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly. Conclusion: The successful implementation of a mix of governance modes in New Zealand 2001-2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participation, and accountability to the centre enhanced through political rather than bureaucratic mechanisms.