• P Howden-Chapman and T Ashton.
• Department of Public Health, Wellington School of Medicine, University of Otago, P.O. Box 7343, South, Wellington, New Zealand. howdenc@wnmeds.ac.nz
• Health Policy. 2000 Nov 1;54(1):27-43.

AbstractThe 1993 Health and Disability Services Act heralded a range of structural reforms in the New Zealand health care system. Despite these reforms considerable resources being spent on convincing consumers of their merits, have failed to gain widespread public approval. This paper examines two key issues that have arisen during the reform process. These are the difficulties associated with trying to set priorities in ways which are effective and politically acceptable, and the relationship between the public and private sectors. Unacknowledged conflicts of interest have helped to undermine the priority setting process. The discussion suggests that it may be increasingly difficult for any government in future to determine the allocation of resources without taking private sector interests and rising public concern into account. It remains to be seen which of these factors is more powerful.

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