The Government is setting its sights on the creation of New Zealand's first national public health service, revealing its plans for a major reform of the health sector.
All of New Zealand's 20 District Health Boards will be scrapped and replaced by one new centralised Crown entity, Health New Zealand.
This would create New Zealand's "first truly national public health service," while also ending the so-called "postcode lottery," according to Health Minister Andrew Little.
A Public Health Agency which will monitor – and be ready to respond to – any health threats to New Zealand has also, been announced.
As has an independent Māori Health Authority which will be tasked with improving Māori health outcomes.
"This is a transformation that is necessary – and overdue," Andrew Little said yesterday.
The significant shake-up drew criticism from National and Act, the latter calling the creation of a Māori Health Authority a "divisive move".
But both the Māori Party and the Greens support such an authority being set up.
The proposed changes are significant and represent one of the biggest reforms of New Zealand's health sector in its history.
The Health and Disability report, released mid-last year, suggested that the number of DHBs should be slashed to between eight and 12.
But the Government went much further in its response, scrapping the system altogether.
"I reached the conclusion that the argument for reducing them [DHBs] from 20 to between eight and 12 was the same idea as getting rid of them altogether," Little told media.
New Zealand, he said, is simply too small to have 20 sets of decision-makers.
Health NZ will be responsible for running New Zealand's hospitals – Little said this will not mean a loss of funding.
Although the new entity will be based in Wellington, it will have four regional offices in: Auckland and Northland, South Island, the Central North Island and the Lower North Island.
Each office will be responsible for hospitals in its region.
The creation of Health NZ could lead to job losses, given the size of the amalgamation.
But Little said there will be a lot of jobs that will transfer out of the Ministry of Health and into Health NZ but did not rule out job losses.
Democratically elected DHB board members will, however, lose their jobs come June 30 next year.
But Little said some members could go into governance roles within Health NZ.
The independent Māori Health Authority will be tasked with creating a national strategy, as well as policies, to help improve Māori health outcomes.
It will be able to directly commission services, according to Associate Health Minister Peeni Henare.
"Many Māori don't like going to the doctor," he said.
That's because for many Māori, their experiences of the health system have been negative, he said.
"That is why we must change."
The Māori Health Authority will have veto powers, according to the Cabinet paper approving the plan.
It will: "act as co-commission for other health services accessed by Māori, working jointly with Health NZ to approve commissioning plans and priorities".
"This would require the Māori Health Authority to jointly agree national plans and operational frameworks [eg the commissioning framework], with clear approval rights including an ability to exercise a veto in sign-off."
Act leader David Seymour said this was divisive and represents a "serious departure from the idea that all New Zealanders have equal rights".
National's health spokesman Shane Reti agreed, saying a Māori Health Authority would create a "two-tiered system," which would be worse for everyone involved.
That's because it would mean Health NZ and Māori Health Authority would be competing for staff as well as funding.
National, he said, supported a health system where the emphasis is on those with the most need.
"We know Māori have the greatest inequity across health and, therefore, greater needs across many health metrics," Reti said.
Te Pāti Māori (the Māori Party), meanwhile, welcomed the announcement.
But co-leader Rawiri Waititi said the "devil will be in the details" when it comes to the rollout of this plan.
"We will be keeping a close eye on how this structure impacts our people on the ground."
The final part of the Government's reform announcement was the creations of a new Public Health Agency, which will act as the "authority on public health knowledge in the system".
That means it will monitor threats to the health of New Zealanders and ensure the Government is ready to deal with them.
There is no price tag for the reforms yet – Little said those were coming next month in the Budget.
But it's likely to be expensive; given health is the second most expensive area of the Government's budget; with twenty cents in every dollar going into health.