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What should governance for integrated care look like? New Zealand’s alliances provide some pointers

Multidisciplinary leadership teams and flexible approaches are helping streamline New Zealand’s health care system

While the search continues for governance arrangements that support health system and service integration,1,2 developments in New Zealand provide useful new insights. New Zealand presently has 20 district health boards (DHBs) planning and funding regional hospital and other services, and around 30 primary health organisations (PHOs) that plan and fund elements of general practice and primary care for enrolled patients. These two sets of arrangements have functioned largely separately from one another, despite DHBs funding PHOs and both having common populations.3 New Zealand’s policymakers and health care providers have concluded that it is no longer acceptable nor sustainable to operate a health system with parallel structures that lack coordination or a governance model that supports this.

In response, from mid 2013, New Zealand moved to implement a governance model across the entire country, aimed at integration by requiring an alliance between each DHB and corresponding PHOs. This followed investment in 2010 in nine pilots. The alliance concept derives from the construction industry, where independent companies collaborate, rather than compete, to ensure that large, complex projects are delivered…