Policy report

From theory to practice: the promise of primary care in New Zealand

Public health Primary health care New Zealand

Colorado Health Institute vice-president Amy Downs spent seven months in New Zealand between February and August 2017 as an Ian Axford (New Zealand) Fellow in Public Policy and was hosted by Treasury.

This is her report of her findings, which examines and reports on the reforms of the early 2000s, central to which were the creation of primary health organisations (PHOs) and the implementation of a universal and publicly-funded capitation programme to subsidise primary care for all New Zealanders.

She makes a number of recommendations that could help New Zealand realise its objectives in primary care. Those recommendations span several domains:

  • Data collection and monitoring
  • Financing and organisation
  • New models of care
  • Policy analysis and leadership


Relative to other countries, New Zealand’s health care system performs well. The system is efficient and ranks well in prevention, safe care, coordination and patient engagement. However, New Zealand doesn't compare as well in terms of access and equity.

To address some of these concerns, New Zealand launched a series of significant health sector reforms in the early 2000s. Those reforms were intended to promote access to care, narrow health inequalities, encourage local innovation and promote 56 integration of services. Not only was the health sector substantially restructured, but significantly more resources were devoted to primary care. While a number of important principles were championed in the restructuring, their advantages have not been fully realised due to a number of factors.

New Zealand needs to encourage more innovation in primary care and understand the effectiveness of different models so that investments are made judiciously and outcomes are aligned with intended objectives. Examples of innovative health system delivery reform exist in New Zealand and have been championed by local leaders. But a lack of monitoring and evaluation has made it difficult to determine whether they should be scaled up.

The good news is that, although they may disagree on the level of government financing and regulation, New Zealand health sector leaders generally agree on a vision for the health system. New Zealand has many thoughtful experts committed to high quality and patient centred care. They are eager to engage with policymakers on specific ways to move that vision forward.

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