Arguing that the New Zealand health system is in crisis, this paper recommend investment in five key priorities based on the principle that to minimise cost growth and increase long-term sustainability without compromising quality, the system needs to be efficient and flexible, and it needs to contribute to economic growth as well as being supported by it. 

Vote Health is the main source of funding for New Zealand’s health system. This paper recommends that the following five solutions are not only urgently needed but would improve system productivity so warrant an increase in Vote Health to achieve them. 

1. Funding and resourcing strong community-based healthcare based on a broad regulated and non-regulated workforce with support for upskilling and access to digital tools to assist them to do more, from home-based care to rehabilitation and needs assessment. 
2. Stronger focus on the end of the care continuum from hospital discharge processes to community discharge support and aged residential care to address hospital “bed block” – the key driver of long ED waits and increasing demand for investment in hospital capacity. 
3. A focus on digital transformation to reduce costly, ineffective and inefficient communication barriers between services as well as between providers and patients, improve the information available to decision makers and support the adoption of technologies that enable remote patient monitoring and care by a broader generalist workforce (including self-care). 
4. A social investment approach to health care to support a productive workforce, ensuring that the health system contributes to, as well as being supported by, economic growth.
5. Increased access to medicines, many of which have demonstrated cost-effectiveness and are waiting on Pharmac’s own list of opportunities for investment, to ensure New Zealanders are not kept unwell and unproductive when there are cost-effective medicines that could help them.