New pram; old rattle: New Zealand's attempt at reconfiguring primary maternity care funding in the 1990s

Abstract

New Zealand has undergone a fundamental transformation in the last 15 years. No area of governmental activity has remained untouched. Included amongst the many reforms, that have been undertaken by various New Zealand governments since 1984, has been the radical restructuring of the health sector. The combination of a new government administration with the free market ideology, popular with key members of the elite, saw the existing Area Health Board health sector structure replaced by the purchaser/provider split. The new health sector model altered existing institutional relationships and created a new group of agencies solely charged with purchasing health services, the Regional Health Authorities. The purpose of these changes was to allow the government to reconfigure health services. To do this the government sought to strengthen its leverage by addressing what was perceived to be the impediment to reform under the Area Health Boards - stake-holder capture. The case study of primary maternity care funding reform provides an opportunity to look into the institutional interplay of the new purchaser/provider health sector, and examine whether the model has achieved what its architects had hoped. Maternity care funding is one of the most complex and problematic areas of publicly funded health care. It has also been a feature of government activities for half a century. Free primary maternity care for all New Zealand women has been provided by central government since 1939. Free maternity care was delivered by a mechanism whereby the government was been responsible for payment to private sector health professionals for a full range of primary maternity care services through the Maternity Benefits Schedule (MBS).