Table 1.

Lessons Learned from the New Zealand (NZ) Experience for US Health Reform

Value of networksNetwork organizations have provided administration, budget holding, incentivized programs, data feedback, peer review, education, human relations, and HIT support and resources. Such organizations have been found to play a key role in better supporting primary care services and service development.
Population approachNZ has successfully enrolled patients with a unique patient identifier (National Health Index) supporting this enrolment. This has allowed networks and providers to focus increasingly on achieving improved health for their enrolled population and has improved accountability through the ability to identify the population being cared for and assess progress in achieving key targets.
Clinical, community, and corporate governanceNZ has developed a mix of clinical, community, and corporate governance arrangements, although how well this mix works is not well researched.
Blended paymentsNZ has successfully introduced a mix of salary, capitation, fee-for-service, and target-driven payments, although the impact of these changes is not well researched.
Interdisciplinary team approachThere is increasing teamwork between doctors, nurses, community pharmacists, other allied health workers.
HIT interoperabilityImproved interoperability is gradually allowing providers to access records and will over time be available to patients as well.
Intersectorial integrationThe government currently is seeking increased devolution of hospital-based services into the community to ensure “better, sooner, and more convenient” services and to reduce pressure on hospitals. The extent of devolution and its impact is not well researched.
Health outcomesWith several years of investment in organized primary care, data show some improvements in patient outcomes. These include rates of immunization; routine screening of patients at risk for cancers, cardiovascular disease, and diabetes; and care coordination of chronic disease patients, with corresponding reductions in hospitalizations.
  • HIT, health information technology.