Did the comprehensive health reforms truly fulfill their promises?
While certain health metrics have seen improvement three years post-reforms, experts Arshad Ali and Ehtasham Ghauri emphasize that access to primary care remains inconsistent across different regions.
When the previous Labour-led government introduced the Pae Ora (Healthy Futures) reforms in 2022, it heralded them as a transformative overhaul of New Zealand's health system, marking a significant shift not witnessed in a generation.
These extensive reforms aimed to eliminate chronic fragmentation within the system, bridge gaps in care based on geographic location, and address enduring health disparities among communities.
Now, three years later—and following a shift in government—what conclusions can we draw regarding the outcomes of these reforms?
In our forthcoming analysis, we delve into this question and find that the results are mixed. While there have been improvements in national coordination for crisis response and planning, many individuals are finding it increasingly difficult to access routine primary care services, particularly GP appointments.
The political transition has also unveiled a crucial lesson: while structural reforms can enhance capacity, the absence of stable political consensus and accountability means that any progress made towards equity is precarious at best.
So, what exactly changed with these reforms?
The reforms replaced 20 district health boards with a single national entity known as Health New Zealand, and established a Māori Health Authority to integrate Treaty-based governance and service commissioning into the healthcare framework.
This was a landmark achievement for New Zealand, as it recognized the leadership of Māori individuals within the health system and upheld the te Tiriti partnership. The underlying goal was straightforward: a more centralized system would facilitate better planning, quicker responses during crises, and deliver more uniform services nationwide.
Our findings indicate that, in some areas, the reforms have indeed been effective. Enhanced central coordination has contributed to better winter planning, equitable workforce pay, procurement processes, and the ability to move patients and resources effectively during demanding times.
During significant weather-related events and seasonal surges, such as Cyclone Gabrielle in 2023, the health system has functioned more effectively as a cohesive unit rather than a disjointed collection of local services.
However, despite these advancements, they have not translated into improved access to everyday primary care, which has emerged as a critical concern among the public.
General practice serves as the frontline measure of the reforms' effectiveness, and the decision made in 2024 to dissolve the Māori Health Authority has further tested the system's resilience.
According to the Health Quality & Safety Commission's 2025 survey, approximately one in five adults reported being unable to obtain care from their usual GP or nurse when needed. This was primarily due to long wait times, shortages of staff, or clinic closures.
These delays at the primary care level often result in more individuals seeking treatment in emergency departments, thereby placing additional pressure on hospitals. Low-income populations, particularly Māori and Pacific communities, are disproportionately affected, highlighting the ongoing inequities that the reforms sought to address.
Although there have been improvements in some health indicators following the reforms, access to primary care remains inconsistent, with affordability and availability continuing to dictate who receives timely medical attention.
These statistics position GP accessibility as a crucial benchmark for assessing whether the health system is fulfilling its promises.
More specifically, this trend reveals a significant limitation of the reforms: while centralization can enhance coordination, it does not inherently ensure accessibility, affordability, or a sustainable funding model for general practice.
In essence, the factors that shape individuals’ daily experiences within the system were never fully addressed by these reforms.
Why does access to GPs remain such a critical test?
These challenges largely exist outside the structural modifications made in the 2022 reforms, yet they significantly influence how people interact with the health system on a daily basis.
Equity was intended to be a cornerstone of the reforms, particularly through the establishment of the Māori Health Authority. The goal was to empower Māori communities in health policy-making, service commissioning, and establishing their priorities. However, the decision to eliminate the Māori Health Authority in 2024 underscored a fundamental challenge faced by New Zealand's health reforms.
Proponents of a single system argue that it enhances efficiency and clarity, while critics contend that it indicates that equity was never solidly integrated but rather remained politically contingent.
The Waitangi Tribunal has determined that the Crown failed to uphold its Treaty obligations in the manner the authority was disbanded.
Regardless of one's political viewpoint, the removal of this authority highlights a deeper issue: reforms based on contentious governance without widespread political support are always vulnerable to reversal.
Consequently, the change in government has illuminated how fragile reform can be when it lacks bipartisan support and robust mechanisms for accountability.
When governance frameworks fluctuate with each election cycle, both continuity and public trust are compromised.
This certainly does not imply that the 2022 reforms were misguided; they were a response to real and well-documented issues.
Before the reforms, the health system was fragmented, inconsistent, and often bewildering for patients and providers alike. Centralization has mitigated redundancy and enhanced national oversight in ways that were challenging under the previous model.
However, the past three years have demonstrated that structural reform alone does not guarantee equity or access to care. Health systems evolve slowly, and outcomes are influenced more significantly by factors like funding, workforce capacity, incentives, and political stability than by organizational charts.
For most New Zealanders, the effectiveness of the reforms will ultimately be gauged not by how well agencies coordinate at the central level, but by whether they can secure an appointment with a GP when necessary, afford that visit, and avoid unnecessary hospitalizations as a result.
By this standard, the reforms remain incomplete, and their future now hinges as much on political dynamics as on policy decisions.
Authors Arshad Ali is a Researcher at the University of Otago; Ehtasham Ghauri is a Principal Lecturer at the University of Otago.
This article has been republished from The Conversation (https://theconversation.com/did-nzs-sweeping-health-reforms-deliver-on-their-promise-3-years-on-the-verdict-is-mixed-272262) under a Creative Commons license.
