Lecturer, Department of Public Health, University of Otago, PO Box 7343 Wellington 6242, New Zealand.
Professor, Massey University, Private Bag 11222 Palmerston North 4442, New Zealand.
N Z Med J. 2023 May 26;136(1576):74-81. doi: 10.26635/6965.6139.
Explicit government policy about ownership of health services is an important yet missing element in Aotearoa New Zealand's health system. Policy has not systematically addressed ownership as a health system policy tool since the late 1930s. It is timely to revisit ownership amid health system reform and increasing reliance on private provision (for-profit companies), notably for primary and community care, and also as an integral part of digitalisation. Simultaneously, policy should recognise the importance and potential of both the third sector (NGOs, Pasifika, community-owned services), Māori ownership and direct government provision of services to address health equity. Iwi-led developments over recent decades, along with the establishment of the Te Aka Whai Ora (Māori Health Authority), and Iwi Māori Partnership Boards provide opportunities for emerging Indigenous models of health service ownership, more consistent with Te Tiriti o Waitangi and mātauranga Māori. Four ownership types relevant to health service provision and equity are briefly explored: private for-profit, NGOs and community, government and Māori. These ownership domains operate differently in practice and over time, influencing service design, utilisation and health outcomes. Overall, the New Zealand state should take a deliberate strategic view of ownership as a policy instrument, in particular because of its relevance to health equity.
明确的政府卫生服务所有权政策是新西兰卫生系统中一个重要但缺失的要素。自 20 世纪 30 年代末以来，政策并未系统地将所有权作为卫生系统政策工具来处理。在卫生系统改革和对私人（营利性公司）提供服务的依赖日益增加的情况下，重新审视所有权问题是及时的，这不仅包括初级和社区护理，还包括数字化的一部分。同时，政策应该认识到第三部门（非政府组织、太平洋岛民、社区所有服务）、毛利人所有权以及政府直接提供服务对于解决健康公平的重要性和潜力。几十年来，毛利人领导的发展以及 Te Aka Whai Ora（毛利健康管理局）和毛利人伙伴关系委员会的建立，为新兴的土著卫生服务所有权模式提供了机会，这些模式更符合《怀唐伊条约》和毛利知识。简要探讨了与卫生服务提供和公平相关的四种所有权类型：私营营利性、非政府组织和社区、政府和毛利人。这些所有权领域在实践中和随着时间的推移运作方式不同，影响服务设计、利用和健康结果。总体而言，新西兰国家应该从战略角度出发，明确将所有权作为一种政策手段，特别是因为它与健康公平有关。
