New Zealand policy strategies concerning the funding of general practitioner care

The evolution of New Zealand health policy concerning general practitioner care suggests six major goals: (1) providing GP services universally at zero or very low user charges, (2) increasing the proportion of GPs in rural and sparsely populated areas, (3) increasing the proportion of primary care going to low-income populations, (4) increasing the effectiveness of primary care in promoting health, (5) lowering the cost of primary care provision, and (6) giving patient-consumers (with particular emphasis on Maori) more control over the environments in which primary services are provided. Policy packages have lacked analytical coherence, however, with the consequence that only some of the goals have been effectively promoted at any point in time. The particular policies promoted have varied over time depending on the political party in power, and on the international climate of opinion concerning the prioritising of goals. The current view is that the most significant shift in New Zealand health policy orientation occurred during 1992-1994, with the emphasis on managed competition strategies and increased reliance on user charges. The 1992-1994 policy reforms also reflect a long-standing orientation in New Zealand df attempting to separate the care of the poor from that of everyone else, and of providing care for the poor by the state in a paternalistic context, and the care for the non-poor in market arrangements that reflect the preferences of patients. (C) 1997 Elsevier Science ireland Ltd.