New Zealand’s 2021 Budget marks the end of a generational experiment with a patchwork of 20 decentralised District Health Boards (DHBs). There are high hopes that bringing responsibility back to the Beehive will end a so-called ‘postcode lottery’ of persistent pockets of severe health disadvantage. The overhaul will require significant new investment to upgrade ICT, data, and digital services.
The restructure of DHBs was announced in April. Having 20 separate districts for a population of 5 million, smaller than Melbourne or Sydney, was more akin to managing a roster of football clubs than a national health system. A review released last year recommended reducing the number; but cabinet decided to get rid of them all. Some boards are elected, others appointed. Some easily attract staff, others suffer chronic shortages. It is difficult to re-deploy assets and services when needed. Each has its own IT system.
The Budget delivers an additional $2.7 billion in operational funding over four years, and one-off capital injection of $700m for facilities, infrastructure, and technology to manage the DHB transition.