Policy mode | Centralised | Decentralisation | Recentralisation | |||
---|---|---|---|---|---|---|
Timeframe | Pre mid-1980s | Mid-late 1980s | Early 1990s | Mid-late 1990s | 2000s | Late 2000s on |
Focus | Universal access | New public management | Efficiency | Value for money | Responsiveness | Performance |
Organisation | Centralised and relatively stable | Regionalisation: 23 area units established | Commercialisation: hospital part-charges introduced | Return to free-at-entry services | Democratisation: partially elected District Health Boards (DHB) | DHB and PC alignment Alliance contracting |
Means of control | Department of Health manages all facets and payments | Policy Ministry with purchasing entity Regional services through contracts and financial targets | Internal market model Hospitals operated as independent business units | Policy Ministry with 4 regional funder-provider authorities | DHB plans and funding agreements with Ministry; New PC focus | Partial re-centralisation New focus on patient-focussed care |