Search

In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

Māori health providers emerged in Aotearoa/New Zealand in the 1980s as a mechanism to achieve self‐determination for Māori communities. However, the contracts funding Māori health providers limit expressions of self‐determination and fail to reflect Te Tiriti O Waitangi, the founding treaty of Aotearoa/New Zealand. Significant health reforms are proposed in Aotearoa/New Zealand, including the creation of a Māori Health Authority that will commission services from Māori health providers. This paper aims to critique the government contracts provided to Māori health providers in the light of the health reforms. A discourse analysis was undertaken on contracts held by a Māori health provider. The study was informed by a Kaupapa Māori congruent methodology that centralised Māori knowledge. The contractural language utilised a variety of discursive techniques that ultimately limit the power of Māori health providers. These discursive techniques included the redefinition of Māori concepts of self‐determination, the use of rhetoric that was not matched by action, reshaping Māori health priorities to reflect the funders' priorities and the application of a deficit lens to Māori health issues. The discursive techniques present in these contracts is consistent with previous work demonstrating a failure of funders to centralise Māori knowledge and ways of being. Success of the proposed health reforms and the Māori Health Authority should require dismantling of non‐Māori ways of commissioning and contracting, otherwise there is the continued risk of discriminatory contracting practices limiting the expression of self‐determination for Māori health providers. [ABSTRACT FROM AUTHOR]

Healthcare reforms in India have been a much-debated issue in the recent past. While the debate has focused mainly on the right to healthcare, another by-product that has evolved out of the debate was the current problem of medical malpractice and the healthcare law. The last decade has seen an increase in the healthcare facilities in the country. This, however, has come with a bulk of medical error cases which the courts have entertained. According to reports, there has been an increase in medical litigation cases by 400% in the last decade. There are about 5.2 million cases of medical error in the country every year. While there exists a standard legal system in the country which entertains such complaints of medical malpractice, the attempt by regulators and medical practitioners should be to reduce these cases. This paper seeks to analyze the extent to which medical malpractice cases affect consumers (patients). It analyzes the existing medical liability system which has mainly evolved through the jurisprudence laid down by the English courts and critiques it. It also looks into the major reasons for such medical mishaps. Authors argue that a "No-Fault" system may give better outcomes. They analyze this by looking at the no-fault liability model implemented in New Zealand. Narratives of no-fault liability being implemented in India have also been used. These are showcased from instances of Motor Vehicles Act, 1988, and Clinical Trial regulations. It is also argued that a by-product of a no-fault liability system is stringent regulations which are used to reduce the possibility of medical mishaps altogether. Lastly, the possible problems of the no-fault liability system are discussed in the paper. [ABSTRACT FROM AUTHOR]

Radical market‐oriented health reforms in New Zealand in the early 1990s failed to deliver key financial targets, resulted in unnecessary patient deaths, adversely affected public healthcare services, induced serious tensions between clinicians and managers and encouraged a predisposition to private healthcare. A more co‐operative health system was implemented in the late 1990s but remaining problems of inadequate patient access led to establishment of a charity hospital in Christchurch which, by November 2018, had registered over 18 000 patient visits. This is one indication of the need to resurrect our public healthcare system. In this paper, we discuss briefly the health reforms of the 1990s then, for discussion and debate, provide seven suggestions for how this resurrection might be achieved thereby avoiding the need for charity hospitals throughout the country. [ABSTRACT FROM AUTHOR]

Personality disorders have received limited recognition as a public health priority, despite the publication of treatment guidelines and reviews showing effective treatments are available. Inclusive approaches to understanding and servicing personality disorder are required that integrate different service providers. This viewpoint paper identifies pertinent issues surrounding early intervention, treatment needs, consumer and carer experiences, and the need for accurate and representative data collection in personality disorder as starting points in mental health care reform. [ABSTRACT FROM AUTHOR]

Purpose – The aim of the paper is to describe the "organisational lifecycle" of the New Zealand Mental Health Commission (NZ MHC) including factors that led to it being established, the evolving phases of the work it undertook and its key achievements, the critical success factors, the rationale behind its disestablishment and transfer of its core functions to another entity. Design/methodology/approach – The methodology is a review of relevant documents and interviews of previous Commissioners, and insights of the final two Chair Commissioners and authors. Findings – The NZ MHC was established to provide government with independent advice on how to develop the capacity and capability of mental health and addictions services for those people with the highest and most complex needs, estimated to be approximately 3 percent of the population. Having successfully led changes to achieve this goal as set out in The Blueprint of 1998 it is now influencing government policy and services to achieve better mental health and well-being for the whole population as per Blueprint II, published in 2012. The NZ Government clearly values the role of Mental Health Commissioner which has been transferred to the Office of the Health and Disability Commissioner from July 2012 at the time the Commission is disestablished. Research limitations/implications – The paper relies on insights of those in Commission leadership roles. Practical implications – Other Commissions may gain insight into their own evolutionary pathways and proactively manage them. Social implications – Optimal mental health and wellbeing for society requires policy that simultaneously takes a "whole of society" approach and focuses on responding to people with the highest needs. Originality/value – The paper shows that there are significant concerns about the disestablishment of the Mental Health Commission in New Zealand and little understanding of the underlying rationale for the organisational changes. [ABSTRACT FROM AUTHOR]

BURRELL B and TRIP H. Nursing Inquiry 2011; : 174-183 In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing 'Prisons of protection' and moral treatment. Secondly the paper traces reforms commencing in the 1960s where changes from institutional care to community care were informed by humanistic ideals, a key driver being the concept of normalisation. Theorists offered competing discourses that formed the bases of arguments for the status quo whilst resistant voices advocated change. Covering such significant changes leads us to assess the state of de-institutionalisation' as it stands today and how it may be perceived in the future. We assert that Foucault's genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de-institutionalisation we question whether a form of re-institutionalisation may be occurring. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents preliminary evaluative findings from research on key areas of concern to Māori and forms part of a wider project on the 2001 health system reforms in New Zealand. The paper reports on the development and implementation of the Māori Health Strategy, representation in decision making at governance level in District Health Boards, the inclusion of the Treaty of Waitangi in legislation and workforce issues. Methods: Key informant interviews with 35 Māori and non-Māori respondents, in addition to data from five case study districts, were thematically analysed to gain an understanding of views on the health system reforms to date. Results: The development of a Māori Health Strategy and the mandatory inclusion of Māori in governance and consultation processes have had a positive effect on Māori participation in the public health sector. Whereas previously Māori participation was concentrated in health service provision, the inclusion of specific provisions in the New Zealand Public Health and Disability Act 2000 has resulted in greater Māori inclusion in governance, planning and decision-making roles. However, there are concerns over strategy implementation, sustainability and workforce development. Conclusions: Overall, the findings at this stage indicate that there is support for the post-2000 model. Māori and non-Māori alike have identified positive features of the model that could go some way towards contributing to improved Māori health. However challenges still remain. [ABSTRACT FROM AUTHOR]

This paper examines the concept of care as it was practised and conceptualised within one hospital group in southern New Zealand during the health reforms. The paper argues that these reforms brought about a division in the labour of care between the broad group of managers, computer analysts, administration officers, and the clinical staff. Aspects of these two empirically derived categories of care are elaborated, as well as the problems associated with each style. While this division in the labour of care is argued to be an unintended local consequence of the New Zealand health reforms, it also represents a more global phenomenon—the abstraction of social life. [Copyright &y& Elsevier]

This paper will seek to explicate the changes in the New Zealand health sector informed by the concepts of problematization, inscription and the construction of networks (Callon, 1986; Latour, 1987, 1993). This will involve applying a framework of interpretation based on the concepts of Latour's sociology of translation. Material on problematization and inscription will be incorporated into the paper in order to provide an explanatory frame of reference which will enable us to make sense of the processes of change in the New Zealand health sector. The sociology of translation will be used to explain the processes which underlie the changes and will be used to capture effects, such as changes in policy and structure, producing new networks within which 'allies' could be enrolled in support of the health reforms. [ABSTRACT FROM AUTHOR]

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

The New Zealand health system was substantially reformed in 1993 with the introduction of a purchaser-provider split, competitive contracting and managerialism. The new system failed to deliver the desired gains and, in 1996, the reforms were "reformed". While there has been widespread study of the 1993 reforms, there has been little discussion to date of the 1996 changes and the emerging directions for New Zealand health policy and service delivery, which remain unclear. This paper discusses the New Zealand health reforms of the 1990s. It briefly outlines the 1993 reforms and their results. Next, it details the 1996 "reforms". Third, it discusses developments since 1996, some of which have emerged out of the 1993 reforms, but which have gathered momentum only since the 1996 changes were announced. In the conclusion, the paper lists some of the directions in which the New Zealand health sector appears to be heading, noting that there is a need for coordination of the sector, and for permanence. [ABSTRACT FROM AUTHOR]

hoare k.j., mills j. & francis k. (2011) The role of government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. Journal of Advanced Nursing 68(5), 963-980. Abstract Aim. This article is a report on a review that examined the role of Government policy in primary care and its association with nurse-led care in the United Kingdom, New Zealand and Australia between 1998 and 2009. Background. The United Kingdom, New Zealand and Australia share a similar model of first point access to the healthcare system via general practitioners. General practice is synonymous with the term primary care. Data sources. Medline, CINAHL, EMBASE, Scopus, PsychInfo, Google, Department of Health, England (United Kingdom), Ministry of Health, New Zealand, Department of Health and Ageing, Australia. Searches of electronic databases from 1998 to December 2009 and hand searches of identified leads and key journals. Historical papers accessed to describe the genesis of practice nursing and historical Government policy documents prior to 1998, were examined. Review methods. A modified realist review was used to synthesize research and policy documents relating to government policies pertaining to nurse-led care. In addition, a systematic review was used to identify literature that described practice nurse-led care. Results. Nurse-led primary care services are well described in the United Kingdom with a total of 45 studies meeting the inclusion criteria for the second review. There are no published studies from New Zealand, and only two from Australia describing nurse-led primary care. Conclusion. New Zealand and Australia lag behind the United Kingdom in practice nurse development. Implementation of clinical governance was fundamental to the development of nurse-led care in the UK. [ABSTRACT FROM AUTHOR]

Mental health law reform in recent decades has drawn on the international human rights movement. The entering into force of the Convention on the Rights of Persons with Disabilities (CRPD) on May 3 2008 has been hailed by some as signalling a new era in relation to how domestic mental health laws should be reformed. Both Australia and New Zealand have ratified the CRPD and Australia has acceded to its Optional Protocol. New Zealand and the Australian Capital Territory and Victoria have statutory bills of rights which have an interpretive effect, but are unable to render other statutes invalid. Drawing on the results of interviews conducted with fifty-two representatives of consumer and carer organisations, lawyers, and mental health professionals across Australia and New Zealand, this paper examines the current thinking on human rights and mental health laws in these countries and outlines what changes, if any, may be brought to domestic legislation in light of the Convention. [ABSTRACT FROM PUBLISHER]

Abstract: This paper considers recent health care reform in New Zealand in the context of the continuing evolution of the ‘neoliberal project’. It advocates the adoption of a Foucauldian governmentality approach to analysis as a productive way to extricate the changing understandings of space within evolving New Zealand health discourses. We analyse two policy documents released 9 years apart which, when examined together, encapsulate the changing discourses of the health care system in the 1990s. We note that through the 1990s the central governing rationality has shifted from competition towards cooperation in health care delivery. While place was held to be subservient to the market at the beginning of the decade, health care has been increasingly re-territorialised through ‘community’ and its associated constructions. [Copyright &y& Elsevier]

New Zealand, like most other developed economies, has struggled to establish the best way of organising and delivering publicly financed health care services. Before the 1990s, hospitals and some related services were planned and provided by regionally based, locally elected health boards. This system was replaced in 1993 with a quasi-market structure in which separate organisations were responsible for the purchasing and provision of services. This in turn was replaced in 2001 by a system of locally elected boards that is remarkably similar to that which existed in the 1980s. The change to and subsequent abandonment of the quasi-market structure implies major changes to the way that health services are organised in New Zealand and suggests policy U-turns in (at least) three key areas: from cooperation to competition (and back); from integration of the roles of purchaser and provider to contractual arrangements (and back); and from local decision-making to centralised decision-making (and back). The aims of this paper are to examine the depth of system change in practice and to consider the extent to which the stated goals of reformers have disguised the degree of continuity between reform eras. We conclude that simplistic distinctions between structural approaches often fail to capture salient influences upon decision-making. New Zealand has not, in fact, been "to market and back" as the rhetoric would have us believe. Key aspects of the health system have endured throughout the reform period and these arguably have more importance for system functioning and performance than the high-level structural changes. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

The closing years of the 20th century were a time in New Zealand dominated by health care reforms inspired by neo-liberal ideology. The result has been changing geographies of public and private health care providers and the evolution of a new discourse of health care. Ascot Integrated Hospital, situated in the affluent Auckland suburb of Remuera, opened in 1999, reflecting and projecting this new discourse. It is a pioneer, competing for patient patronage in a contracting market for surgical and medical providers. In this paper we survey the recent history of private hospital developments in New Zealand, then more closely consider the Ascot, a hospital that has deployed language to construct itself and its achievements in the public imagination. Given the context of an extremely competitive environment for private patients, this construction glamorises medicine and links healing with a contrived place. We conclude that texts associated with the Ascot provide a useful vehicle for advancing cultural geographies of health care and ideas of the place of hospitals in western capitalist countries. [Copyright &y& Elsevier]

This paper uses two case studies to examine the scope for medical practitioners to utilize alternative forms of diagnosis and treatment The first is a specific study of a medical practitioner who was deemed to have transgressed the boundaries of orthodox medicine. The second is a general case study which examines the possible effects of a new medical practitioners bill and the New Zealand health reforms. it is suggested that when the medical profession is faced with external threats it attempts to strengthen itself at the cost of limiting the autonomy of its membership. [ABSTRACT FROM AUTHOR]