The District Health Board and GP systems may be in for a shake-up after a major report describing New Zealand's healthcare as fragmented, overly complicated and lacking leadership at all levels.
A sweeping, Government-commissioned review into the whole health and disability sector on Tuesday delivered its 300-page interim results, raising a series of major concerns about what it said was an overall good system.
It's the largest review of the sector in decades.
Among other issues, the interim report describes the current system as muddled and simply too complicated for those using it.
The review's chair, former prime minister Helen Clark's chief of staff, Heather Simpson, told the Herald there was a lack of logic to the way many services interacted.
"Within even the primary care system you pay for some services and you don't pay for others. You need a referral for some things and not for others," she said.
"Many patients would have had the example of having to go into three different specialists and tell three different people each time their medical history or what their prescriptions are … that gets very complicated.
The review also says there's a lack of collaboration in the sector and a lack of leadership across the board.
"We are not good at learning from part of the system and applying that to somewhere else," Simpson said.
"We need a culture of leadership … At the moment we have very confused accountabilities in different parts of the system so everybody can say: 'It wasn't me, it was them'.
The interim report doesn't make any recommendations – those will come with its final verdict in March next year.
But it does raise a series of questions hinting at where it might be going.
Among them are whether it would be better to have fewer DHBs, DHBs with different functions or more sharing of resources at the national level going forward.
Simpson said there was still broad support for the idea of health boards managing the health of communities.
"[But] whether it's those particular structures and how many of those there ideally should be going forward is something we've left open going forward."
Similarly, the future of elected health boards has been thrown up in the air.
"There needs to be better planning, you need to engage your community in planning services … The question that is still open is whether electing people onto boards is the best way of achieving that or not," Simpson said.
That could include different proportions of elected and appointed board members, different election systems or even entirely appointed boards, she said.
Simpson said there were also questions about how GP services would be organised going forward, especially with a worsening global shortage of general practitioners.
"GP services are a fundamental part of the system and have been at the centre of the way we manage that. We do say in the report that we want to look more at whether those services should be centre of the system or just a fundamental part of it," she said.
"There needs to be going forward more community health hubs in some places, where it's not just a particular GP practice but other health services are available.
The review also noted concerns about inequality in the system were widespread, saying Māori in particular had been not well served, and that there were reports of systemic racism in the health system.
It's also not worked well for poorer and rural communities.
"The urgency for making improvements to outcomes for Māori, Pacific peoples, and low-income and rural households means priority needs to be given to getting more appropriate services to these communities, rather than simply making system-wide changes in the hope that the benefits trickle down," the authors said.
Meanwhile, National Party health spokesman Michael Woodhouse said it was disappointing there were no recommendations.
"After 11 years, a massive review and a 300-page report, it's time the Government provided clarity on what it wants to do with our health system," he said.