Revolving Doors: New Zealand's Health Reforms.

• Author: Ashton, Toni

By Robin Gauld, Institute of Policy Studies, Victoria University of Wellington

Revolving Doors was published as part of the Institute of Policy Studies work on the evaluation of social policy and social service delivery. A book on the health sector is certainly timely, given that the public health system in New Zealand has undergone what the author, Robin Gauld, calls "incessant policy changes" over the past two decades. These changes have included several waves of structural change at the system level, as well as ongoing incremental developments at the service-delivery level. This book provides a detailed account of these changes.

The book begins with an introduction, which includes a summary of the key themes that emerge from the book's exploration of New Zealand's experience of health sector restructuring. Some of these "themes" are simply observations, such as "since the formation of the area health board system, the health sector has been under constant structural change". Others provide useful insights into the development and implementation of health policy, if not public sector policy more widely. Examples include, "the process of adaption takes at a minimum two years, possibly more", and "many politically desirable changes could take place within existing structures".

Following the introduction, Gauld provides an historical overview of the early formation and development of the public health system from 1840 through to the 1970s. These developments are not only of historical interest: they also explain the sources of many of the perceived problems that the recent reforms have been attempting to address.

The remaining chapters cover the main reform periods in chronological order. Chapter 3 covers the 50-year period from 1938 to the end of the 1980s. It describes the problems that began to emerge in the health sector during this time and the various unsuccessful attempts made to reform the system. Chapters 4 and 5 cover the period the fourth Labour government was in power (1984-1990). Chapter 4 gives an overview of the general economic and political reforms that were introduced, including the philosophy and theories that underpinned these reforms. Chapter 5 then focuses on the public health sector. It describes the two major reviews that were undertaken during this period (the Health Benefits Review and the Hospital and Related Services Taskforce), and provides an assessment of the strengths and weaknesses of the health sector in the...