Integration, accountability and decentralisation of Crown Health Enterprise decision making.

New Zealand is possibly moving further than any other western country in achieving a decentralised, integrated, accountable and population-based health system. However, this progress owes as much or more to the reforms implemented through the area health board system, particularly general and service management, than the current reform process. Services have largely replaced hospitals as organizational entities. The leading edge of CHE service development should not be high-tech services but primary health care (PHC). Progressive CHEs are implementing a PHC service as a structure for managing their own PHC services and to begin the necessary dialogue with GPs and other non-government PHC providers.