Rationing healthcare in New Zealand: the use of clinical guidelines

A 1991 "Green and White Paper", Your health and the public health. A statem ent of government health policy, advised that healthcare services in New Ze aland could be rationed by a simple list. The Health and Disability Services Act 1993 provided a framework for resour ce allocation. The Core Services Committee rejected the "Oregon approach" of using a simpl e list to determine what condition/treatment pairs should be funded, prefer ring the development of clinical guidelines as a basis for assessment. Clinical priority assessment criteria derived from guidelines are used to d efine the degree of clinical benefit for public funding. Criteria have been developed for entry into end-stage renal failure program s, access to coronary artery surgery, and entry into booking systems for ot her elective services. The development of clinical criteria to define access to services has had a difficult road, but is a start in defining public expectations of New Zeal and's healthcare system.