LOST IN THE MARKET - A SURVEY OF SENIOR PUBLIC-HEALTH SERVICE MANAGERS IN NEW-ZEALANDS REFORMING HEALTH SYSTEM

In 1993, New Zealand implemented radical health sector reform, separat ing purchaser from provider and creating a competitive market. This pa per reports on a 1994 survey of senior managers' perceptions of how we ll public health services were adapting to this more commercial enviro nment. An initial questionnaire to chief executive officers of Crown h ealth enterprises, the main providers of public health, as well as sec ondary treatment services, was followed by a telephone survey of manag ers of public health services. Chief executives expressed generally po sitive views about the importance of public health, especially health promotion, within their organisations. Public health managers indicate d a wide range of negative and positive views about the new system. Th ey were concerned especially about service fragmentation, diminished i nformation-sharing and decreased collaboration, especially with Maori and general practice providers. Questions were raised about the compat ibility of competition with the need for collaboration in public healt h. The major issue was the inefficient, costly, conflicting and fragme nted purchasing arrangements for public health. Managers wanted unifie d systems and fewer purchasers. More positive views were expressed on an improved focus on outputs and clearer directions, and none wanted t o return to the former era of an entirely separate system for public h ealth services. The abolition of the Public Health Commission during 1 995 should lead to increased integration of purchasing and policy maki ng, but important questions remain about the place of public health se rvices, especially in their links with primary care.