BEYOND IDEOLOGY - THE EMERGING ROLES OF NEW-ZEALAND CROWN HEALTH ENTERPRISES

New Zealand has experienced radical public sector restructuring over t he last decade, including the corporatization and subsequent privatiza tion of state trading units and the reform of social services, includi ng health. In 1991 a new government proposed and then implemented more radical health reforms, which included the corporatization of state-o wned provider units (23 crown health enterprises) and the creation of an internal market with purchasers (four regional health authorities) separated from providers. Interviews with chief executives of crown he alth enterprises suggest that provider units are seeking a wider role than envisaged, with an interest in the health needs of their populati ons and undertaking some purchasing on their behalf. The purchasers se e a narrower role for crown health enterprises. Both purchasers and pr oviders report that competition between providers is not particularly helpful (and with only limited opportunities for this to occur), with collaboration being seen as more useful. Providers are critical of pur chasers' ability to adopt a strategic approach. Unlike other aspects o f New Zealand's restructuring, there appears to be a retreat from some of the more radical facets of the reforms, reflecting both the resist ance of the health sector and a newly uncertain political climate.