In 2000, not long after Prime Minister Helen Clark’s Labour Government had commenced, it was announced that the National Health Funding Authority would be disestablished. In its place would be a set of District Health Boards across New Zealand who would be allocated money from the budge and be saddled with the responsibility for prioritizing its use and distributing the money accordingly. 18 years later, another Labour Government is reviewing it.
I am personally not very surprised a review is coming. District Health Boards have never really struck me as the most efficient method of dispensing funding, however good the idea of a democratically elected board to oversee the prioritization might be (and is). A significant portion of the money is locked up in administrative costs.
Yes, there is no doubt that governing something as big as a national health system is a huge task and the system of governance is something that must be robust. For that there is equally no doubt that the systems needed will be comprehensive and that there will be many tasks that are not obvious to the public eye that need performing.
But do we really need 20 district health boards? New Zealand geographically is generally recognized as being Northland, Auckland, Waikato, Bay of Plenty, Taranaki, Manawatu, Gisborne, Hawkes Bay, Wairarapa, Wellington, Nelson, Marlborough, Canterbury, West Coast, Otago, Southland, West Coast.
The unfortunate saga of Nigel Murray of the Waikato District Health Board was a rare but notable example of a District Health Board chief going rogue with huge personal misuse of money that he had no personal right to. However this is not the cause of the problems that go on in the District Health Boards. More likely the problems stem from the appalling lack of public interest in elected D.H.B.’s – is it possible that they realise there are possibly more effective ways of governing the health system in New Zealand than half baked boards behaving like a television that is trying to function with only half the necessary power available, that is smoking and smouldering its way into some sort of oblivion? Because to be coldly honest, people simply do not have much interest in how the D.H.B.’s work and nor do they terribly care about who gets elected to the Boards because one way or the other something will stuff up.
Back in 1999, following the failure of the Crown Health Enterprises, which established a series of entities meant to act like businesses and make a profit, the National led Government of Prime Minister Jenny Shipley was casting around for alternative means. Their solution was a centrally funded Health Funding Authority which would allocate money based on population size from Wellington. Unfortunately for National the solution was never realized as the party was swept from office by the Labour Government of Ms Clark.
I have written in other articles about the savings that I think could have been made from not having the D.H.B.’s. There has been much written about the poor prioritizing of spending in some D.H.B.’s such as the Canterbury District Health Board, where in the post earthquake environment there were increasing demands for additional mental health services. Whatever model the Government comes up with needs to be able to address the long term growth in demand for services.