Policy-making in a restructured state: The case of the 1991 health reform policy in New Zealand

The pressure for efficiency and accountability that led to reform of public institutions worldwide has had implications for public policy-making as we ll as the management of public services. The difficulties of providing a co ordinated and efficient policy process that can respond to the requirements of a more managerialist style of government were evident in New Zealand in the 1980s and early 1990s. The policy process in 1990-91 leading to the in troduction of health reform proposals provides an illuminating case study o f the tension between participation and speed and between traditional plura list and managerialist approaches to policy development. The implications o f this for subsequent implementation are discussed.