Barriers to health system change in New Zealand

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dc.contributor.advisor Gorman, D en Campbell, Joan en 2020-08-18T23:11:12Z en 2019 en
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dc.description.abstract The present health system is reported as unsustainable and without major system change incapable of coping with public expectations, an ageing population and changing demographics. This thesis identifies some of the major barriers obstructing change, particularly over the past 82 years, and provides an overview of the potential for system change. The historical analysis revealed no reform of the system since 1938 and no new ideas that transformed the system structure or the institutions within it. The institutional components, like deck chairs on a ship, were rearranged but not reformed. The historical findings were reinforced by raw data from 43 semistructured interviews, carried out in four institutional groups within the health system, and analysed using the qualitative inductive method of Thomas 119. System illiteracy by consumers and health professionals was identified as the common theme and bond that held all the historical and contemporary barriers intertwined. The consequence of this ignorance for participants was a lack of clarity about the system, its governance, components, relationships and functions. System change therefore cannot come from within. Without a system mandate there is regular institutional rearrangement and uncertainty with electoral cycles, because there is no bi-partisan agreement about health system governance or purpose. Policy writers and decision makers have looked back to the last electoral cycle and failed to see or appreciate the repetitive perturbations of the past. A mandate and purpose allow for new ideas to be generated and sustained. The potential for a reformed health system could emerge from such a mandate. Idiographic, inductive and nomothetic methods were used in this research. From interpretation of the findings a conceptual framework was constructed. It contains one new idea - a proposed mandate for future health legislation in 2020 and beyond, that addresses the barriers to health system change identified in this study. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99265308511202091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
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dc.title Barriers to health system change in New Zealand en
dc.type Thesis en Public Health en The University of Auckland en Doctoral en PhD en
dc.rights.holder Copyright: The author en
dc.rights.accessrights en
pubs.elements-id 810551 en
pubs.record-created-at-source-date 2020-08-19 en

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