International Journal of Health Policy and Management

International Journal of Health Policy and Management

New Zealand Pae Ora Healthcare Reforms 2022: Viable by Design? A Qualitative Study Using the Viable System Model

Document Type : Original Article

Authors
Adeel Akmal 1, 2
Nataliya Podgorodnichenko 3
Robin Gauld 4
Tim Stokes 1
1 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
2 Department of Business Studies, University of Iceland, Reykjavik, Iceland
3 DBA Programme, Otago Business School, University of Otago, Dunedin, New Zealand
4 Department of Management, Otago Business School, University of Otago, Dunedin, New Zealand
10.34172/ijhpm.2023.7906
Abstract
Background 
The New Zealand (NZ) Pae Ora (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Māori Health Authority (MHA) (Te Aka Whai Ora) – the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform, we aimed to conduct an early evaluation of the design of the reforms to determine if they can deliver a viable and sustainable NZ health system going forward.
 
Methods 
The evaluation was informed by Beer’s viable system model (VSM). A qualitative exploratory design with semi-structured interviews and documents analysis using thematic analysis was used. We conducted 28 interviews with senior healthcare managers and reviewed over 300 official documents and news analyses.
 
Results 
The VSM posits that for a system to be viable, all its five sub-systems (operations; co-ordination; operational control; development and governance) need to be strong. Our analysis suggests that the health reforms, despite their strengths, do not satisfy this requirement. The reforms do appreciate the complexity of the healthcare environment: multiple stakeholders, social inequalities, interdependencies. However, our analysis suggests a severe lack of detail regarding the implementation and operationalisation of the reforms. Furthermore, resourcing and coordination within the reformed system is also unclear.
 
Conclusion 
The health system reforms may not lead to a viable future NZ health system. Poor communication of the reform implementation and operationalisation will likely result in system failure and inhibit the ability of frontline health organisations to deliver care.
Keywords
Health Reforms
Viable System Model
Health Policy
Qualitative Research 
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International Journal of Health Policy and Management
Volume 12, Issue 1
2023
Pages 1-13

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  • Received Date 22 December 2022
  • Revised Date 25 October 2023
  • Accepted Date 20 November 2023
  • First Published Date 21 November 2023
  • Published Date 01 December 2023