New Zealand’s bold new structural health reforms: The Pae Ora (Healthy Futures) Act

Abstract

New Zealand has implemented a transformative overhaul of its public health system. Regulated by the Pae Ora (Healthy Futures) Act 2022 (NZ), the system has two key objectives: first, greater centralisation, with 20 regional district health boards replaced by two central commissioning agencies. New Zealand has a truly national health system for the first time, an aim being to end the “post code lottery”. The second driver is to finally “get real” in tackling persistent inequities in health outcomes and access of disadvantaged groups, especially Māori, New Zealand’s indigenous people, via various initiatives, including creation of a Māori Health Authority. A revolutionary aspect of the reforms is that the principles of the founding Treaty of Waitangi between Māori and the Crown have been embedded in the legislation as high-level guiding principles for all entities. Well-intentioned aims are a good start, but will need to be matched by realistic funding if the reforms are to have any chance of success.