Structure of the health care system

Central government is accountable for the health and disability services within New Zealand. The Minister of Health is the principal adviser of the health and disability sector. He takes responsibility for the Ministry of Health and District Health Boards. Advisory committees also are involved in this sector. The Ministry of Health develops policies regulations, health strategies, and allocates funding to the 20 District Health Boards (Ministry of Health, 2016a).


Components of the health system


Retrieved from



The majority of funding for the Health and Disability system in New Zealand is from general taxation, known as vote health. Vote health accounts for one fifth of government spending, totaling $16,142 million in 2016. DHBs receive 75% of the vote, 16% goes to national health and disability services. Accident compensation corporation (ACC) is another source of funding that covers the cost of delivering healthcare (Ministry of Health [MOH], 2016b; The Treasury, 2016).


Health decisions

The MOH develops nationwide health strategies for central government. The health strategy and a strategy developed for disability support services provide the framework, which underpins the delivery of healthcare services (MOH, 2016b).


Healthcare priorities and targets

Health targets provide a direction and focus for healthcare in NZ. There are 6 health targets set out for 2016/2017:

  • Shorter stays in ED
  • Improved access to elective surgery
  • faster cancer treatment
  • increased immunisation
  • better help for smoking cessation
  • raising healthy kids


Key healthcare areas of the healthcare strategy

There are five strategic themes outlined in the health strategy

Retrieved from


Primary, secondary and tertiary care

Primary health organisations (PHO) provide essential care services including diagnosis, treatment, screening, in the community. The primary healthcare strategy underlines the delivery of care in local community services such as general practitioners. It has a focus on improving and maintaining population health through health promotion and prevention. Community involvement is an essential component to these models as reducing health inequalities between different groups requires partnership with other services. Additionally, primary healthcare models coordinate care services to offer culturally relevant, continuity of care (Ministry of Health, 2001; Primary Health Care Advisory Council, 2009).

‘The most important aspect of community health is that it allows to participate in    decision and policy making’

Examples of PHO: general practitioners, chemists, practice nurse


Secondary health care is specialized care that either requires a referral from a PHO or can be accessed privately through insurance. These providers offer care that requires specialized knowledge and skills that PHO are not able to provide.

Examples are: physiotherapists,  opthomologist, gynocologist.


Tertiary care providers specialized consultative care that is received on referral from primary and secondary medical care. Tertiary services are usually provided as an inpatient service or advanced medical institutes.

‘A nurse running a cardiac rehabilitation programme is an example of tertiary care’




Key points:

  • The most important characteristic of a healthy community  is it provides the opportunity for community members to participate in decision and policy making
  • The Ottawa Charter for health promotion can be described as a social model of health promotion.  The main advantage of such a model is that it improves community health by focusing on social injustices
  • looking at the needs of populations is a key feature of the current New Zealand Primary Health Care Strategy
  • It is anticipated that changes in the health care system will include more emphasis on illness prevention instead of illness treatment resulting in an emphasis on community health
  • In order to be culturally competent when nursing in the community a nurse needs to have the knowledge and flexibility to modify ones own mode of intervention so that it is culturally appropriate to the client
  • The purpose of encouraging people to enroll with a Primary Health Organisation is to provide affordable comprehensive health services




Primary healthcare strategy:

NZ health strategy:

Health strategy roadmaps of actions:





Ministry of Health. (2001). The primary health care strategy. Wellington, New Zealand: Ministry of Health.

Ministry of Health. (2016a). Overview of the health system. Retrieved February 14, 2017, from

Ministry of Health. (2016b). Funding. Retrieved February 13, 2017,  from

Primary Health Care Advisory Council. (2009). Service Models to meet the aims of the Primary Health Care Strategy and deliver better, sooner, more convenient Primary Health Care. Retrieved from

The Treasury. (2016). Vote Health: The estimates of appropriations 2016/17. Retrieved from