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PubMedDate not supplied

On a hiding to nothing? Assessing the corporate governance of hospital and health services in New Zealand 1993-1998.

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.

Governing Board↗
PubMed2003

Factors affecting commercial application of embryo technologies in New Zealand: a modelling approach.

New reproductive technologies include sexed sperm and embryo-based technologies. The technology of sperm sexing, for various reasons, is not available in New Zealand and its use has not been modelled. Embryo technologies are however already in use on a limited scale and various scenarios for their use in both the dairy and beef industries in New Zealand have been modelled. This review briefly discusses the various technologies available and some of their potential strengths and weaknesses. In the dairy industry, modelling has been used to simulate the production of breeding bulls for large breeding companies and the production of replacement heifers in dairy herds. For the beef industry, similar modelling has been carried out to determine the opportunities for more efficient beef production. All the models confirmed that at current levels of performance, embryo-based reproductive technologies are usually not profitable in New Zealand except in niche market situations where the returns from the resulting offspring are significantly greater than can be obtained from natural mating or artificial insemination (AI) reproduction systems. This is confirmed by the low uptake of these technologies in this country to date. Even if performance lifts to levels similar to AI, profitability is likely to occur only if the costs of pregnancies to embryo-based reproductive technologies can occur at prices less than two to four times greater than AI or natural mating. This break-even requirement depends on the returns that can be achieved and the advantages that can be captured by the technology over and above those available from AI or natural mating. Two new uses for reproductive technologies in dairy cattle could be the proliferation of novel or rare genotypes from gene discovery programs and improving the female reproductive rate for optimal marker assisted selection. In both these uses the technology is not at present competing with AI or natural mating. The challenge exists therefore for the biological scientists to satisfy these requirements, coupled with the ethical and human factors involved in the introduction of any new technology. Potential end users of the technologies have been surveyed. They are quite positive about the technologies provided they can use them profitably and are keen to obtain more information about them.

Animals↗
PubMedDate not supplied

Alcohol and road safety behaviour among New Zealand tertiary students.

In New Zealand, as in most developed countries, rates of injury mortality and morbidity peak in late adolescence (15-19 years), when they account for around three quarters of fatalities and a third of hospitalisations. Road traffic crashes account for over half of fatal injuries in New Zealand as in most developed countries. Individuals engaged in post-secondary education, i.e., tertiary students, are a large and important subgroup of young people exposed to the risk of road traffic injury. The aims of this study were to estimate the prevalence of unsafe road behaviours and to examine the role of demographic variables, alcohol use, driver licence status, and transport needs. Participants were 1,480 students (899 women) from 12 residential halls in Dunedin, New Zealand. They anonymously completed a questionnaire on alcohol use and road safety at the start of the 2000 academic year. A sub-sample of 967 students completed a follow-up survey six months later. The mean age of the sample was 18.3 years (SD=1.6), and 88% had a driver licence. Male gender and drinking status were independently associated with speeding, drink-driving and drink-riding, but not seatbelt use. Drinking levels showed a strong dose-response relationship with the prevalence of unsafe behaviours with the exception of seatbelt use. In marked contrast to drinking levels, which increased from baseline to follow-up, drink-driving and drink-riding levels decreased, probably reflecting the reduced motor vehicle transport needs of students in residential halls, relative to their out-of-term living environments. In addition to various existing, evidence-based countermeasures, application of interventions for reducing hazardous drinking may be required to help reduce road traffic injury rates in this population.

Accidents, Traffic↗
PubMed1988

Prevention and control of hypertension in New Zealand: a reappraisal.

A new national policy for the prevention and control of hypertension is required in New Zealand. The first priority is the prevention of hypertension with the development of a population strategy directed at encouraging healthy nutritional and exercise habits. Pharmacological management or specific nonpharmacological treatment of individuals is the second priority and decisions about treatment levels have important logistic and cost implications. Given the limited absolute benefits of treatment to individuals, the current policy of initiating treatment at a diastolic blood pressure of greater than or equal to 95 mmHg should be revised upwards. A population approach to the prevention of hypertension is essential in New Zealand because the majority (57%) of excess deaths due to raised blood pressure occur in people with diastolic blood pressure in the range 80-94 mmHg. A fall in the population mean diastolic blood pressure of 2 mmHg would have the same effect on total mortality rates as the successful treatment of everyone with a diastolic blood pressure greater than or equal to 100 mmHg. A national multidisciplinary group should be established to formulate strategies for preventing hypertension in New Zealand and to review current treatment guidelines.

Adult↗
PubMed1995

Alcohol licensing system changes and alcohol consumption: introduction of wine into New Zealand grocery stores.

New Zealand permitted grocery stores to sell table wine products beginning April 1990 with the implementation of a new Sale of Liquor Act. The number of licensed outlets for retail sales of wine for consumption off-premises increased substantially. Using an interrupted multiple time-series design with nation-wide quarterly alcohol sales data from 1983 to 1993, we assessed the effects of the policy change on sales of wine. Results from Box-Jenkins time-series models revealed a 17% increase in wine sales associated with the introduction of wine grocery stores. Increased sales were limited to the specific category of alcoholic beverages permitted in grocery stores--table wine. Sales of fortified wine, distilled spirits and beer did not increase. We conclude that expansion in retail availability of wine is associated with increased sales and consumption.

Alcohol Drinking↗
PubMed1995

Defining core health services: the New Zealand experience.

The New Zealand health service has been extensively changed over the past four years, with the introduction of four new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a "core" and no list, either positive (inclusions) or negative (exclusions), has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scarce resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need.

Advisory Committees↗
PubMed2003

Graduated driver licensing: the New Zealand experience.

In New Zealand, on 1 August 1987, a three-stage graduated driver licensing (GDL) system that applied to all new drivers aged 15-24 years was introduced. The essential elements of GDL were a 6-month learner license (supervised driving) and an 18-month restricted license stage (with restrictions on night driving and carrying passengers). A blood alcohol limit of 0.03 mg% applied at both stages. EVALUATION STUDIES: Early studies indicated that young people were reasonably accepting of the restrictions, with the passenger restriction being the least acceptable. Problems of compliance with the restricted license driving restrictions were reported. Evaluations of the impact of the graduated driver licensing (GDL) on serious traffic-related injury showed that up until 1991-1992, an 8% reduction could be attributed to GDL. At this time, it was considered that reduced exposure was the main reason for this reduction. However, the number of fatalities and hospital admissions among young people continued to decline, as did the population rate and the rate per number of licensed drivers among the young driver age group. A further evaluation study showed that drivers with a restricted license had a smaller proportion of crashes at night, and with passengers, compared with drivers licensed before GDL. IMPACT OF GDL: These results suggested that GDL restrictions had contributed to the reduction in crashes among young people and that it was not simply a case of reduced exposure to risk. An update of the most recent crash statistics indicated that, compared with older age groups, the fatal and serious injury crash rate among young people has remained substantially below the pre-GDL level. This suggests that the impact of GDL has not diminished over time.

Accidents, Traffic↗
PubMed2000

A case study of health goals in New Zealand.

OBJECTIVE: This paper outlines the New Zealand experience in using health goals and examines its strengths and weaknesses from an 'insiders's' perspective. METHOD: This paper reports on a review of the New Zealand health goals framework conducted in 1996-97. The review centred on a discussion paper, written submissions on it, and consultation meetings with the public, the public health sector and relevant government agencies. RESULTS: It is argued that the framework usefully shaped public health activity in New Zealand and should be retained with a focus on strengthening public health action. Health goals have been developed in New Zealand at a time of considerable change in the health sector. Although this change has been disruptive, it has also provided benefits such as the emergence of new providers. The strengths of the New Zealand framework have included: its inclusiveness, the consultation that occurred in developing it, and the monitoring and reporting system. Ongoing challenges, such as reorienting the health sector and developing a formal intersectoral strategy, are also identified. CONCLUSION: The paper concludes that the current health goals framework has the potential to frame future public health action in New Zealand, but that the increasing mainstreaming of the public health function poses some risk. IMPLICATIONS: The insight provided by the New Zealand case on the implementation of a health goals framework may assist public health planners in other jurisdictions.

Forecasting↗
PubMedDate not supplied

A diet high in saturated fat and sucrose alters glucoregulation and induces aortic fatty streaks in New Zealand White rabbits.

A new and convenient animal model for studying peripheral vascular and coronary artery disease in diabetes was established in this study. Male New Zealand White rabbits weighing approximately 2 kg were divided into 2 groups: a normal control group fed standard laboratory chow and a diabetogenic diet-fed group received a high-fat/high-sucrose diet. The high-fat/high-sucrose diet (contained 10% lard and 37% sucrose) feeding was maintained for 6 months. Plasma total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, superoxide dismutase, nitric oxide, nitric oxide synthase, insulin, and glucose were quantitated at monthly or bimonthly intervals. The aortic fatty streak lesions were quantified following lipid staining with Sudan IV. The aortic samples were observed by electron microscopy. High plasma triglyceride and glucose concentrations were induced. At the end of 6 months, the aortic fatty streak lesions were present in the animals' vascular specimens. As far as we know, this is the first report that demonstrates that New Zealand White rabbits can develop obvious aortic fatty streaks by feeding a high-fat/high-sucrose diet. Our results suggest that New Zealand White rabbits fed a high-fat/high-sucrose diet would provide a convenient model for studying peripheral vascular-and coronary artery disease in diabetes.

Animals↗
PubMedDate not supplied

Reform of the New Zealand healthcare system.

New Zealand's healthcare reform has come in two waves. In 1983, Area Health Boards assumed responsibility for purchasing and providing all secondary healthcare; but a parallel, centralized system of primary healthcare benefits persisted, frustrating attempts to integrate services. In 1991, a new government reorganized public hospitals into "Crown health enterprises," and planned to introduce user fees, competition with the private sector and a list of core benefits. Over the following few years, some of these attempts progressed slowly or were abandoned altogether. They are also attempts to shift risk and expenditure, rather than design a more fair and efficient healthcare system.

Efficiency, Organizational↗
PubMed1987

The New Zealand health system.

New Zealand has developed a dual public/private system of healthcare that gives a high standard of care to all regardless of financial status. Its challenge is to maintain that standard while allowing an opportunity for those who wish to make their own provisions for more agreeable and convenient service.

Delivery of Health Care↗
PubMed1987

Implications of policy and management decisions on hospitals: a New Zealand viewpoint.

In New Zealand, the effect of resource constraint operates at two levels. In the macrocosm of national politics, there is a tectonic collision between two plates--social equity and a fiscal constraint on government expenditure. In the hospital, these forces are reflected in the frustration of the staff who cannot deliver that which they are trained to deliver, in the distress of those who cannot obtain the care they have been told they need and in the stress on management pushed by forces it cannot control. If there is to be resolution, there must be change on all three fronts--the expectations of professionals and users alike--and the approach of management. Perhaps the needed change in management could be the key to change in the expectations of the other two parties.

Health Resources↗
PubMed2006

Miocene mammal reveals a Mesozoic ghost lineage on insular New Zealand, southwest Pacific.

New Zealand (NZ) has long been upheld as the archetypical example of a land where the biota evolved without nonvolant terrestrial mammals. Their absence before human arrival is mysterious, because NZ was still attached to East Antarctica in the Early Cretaceous when a variety of terrestrial mammals occupied the adjacent Australian portion of Gondwana. Here we report discovery of a nonvolant mammal from Miocene (19-16 Ma) sediments of the Manuherikia Group near St Bathans (SB) in Central Otago, South Island, NZ. A partial relatively plesiomorphic femur and two autapomorphically specialized partial mandibles represent at least one mouse-sized mammal of unknown relationships. The material implies the existence of one or more ghost lineages, at least one of which (based on the relatively plesiomorphic partial femur) spanned the Middle Miocene to at least the Early Cretaceous, probably before the time of divergence of marsupials and placentals > 125 Ma. Its presence in NZ in the Middle Miocene and apparent absence from Australia and other adjacent landmasses at this time appear to reflect a Gondwanan vicariant event and imply persistence of emergent land during the Oligocene marine transgression of NZ. Nonvolant terrestrial mammals disappeared from NZ some time since the Middle Miocene, possibly because of late Neogene climatic cooling.

Animals↗
PubMed1994

The economics of dental practice in New Zealand, 1974-1993.

New Zealand Dental Association survey data were used to explore trends in the principal indicators of dental practice economics over the last two decades. Gross income in the most recent financial year, 1992, was the highest during this period. However, the costs of dental practice have also risen, and now absorb close to 60 percent of revenue compared with around 50 percent in the early 1970s. As a result, real net income has yet to return to the "peak" levels achieved in the mid-1970s. Nevertheless, average real net incomes earned in 1992 (in 1988 dollar terms) of $85,701 is around 8 percent higher than the average real net income between 1974 and 1992 of $79,243. Furthermore, the lower income tax rates applying in the post-1990 period have produced post-1990 after-tax incomes which are higher in real terms than those in the pre-1990 period. The trends in real net dental income earned by dentists between 1982 and 1992 are shown to correspond closely to the trends in the average incomes of higher-income consumers. The rate of increase in the fees charged by dentists between 1978 and 1993 has, for most services, exceeded the rate of increase in consumer prices generally. A notable exception is the fee charged for complete dentures, which displayed much more modest increases. It is possible that this is attributable to the presence of competing suppliers (dental technicians) for this service.(ABSTRACT TRUNCATED AT 250 WORDS)

Economics, Dental↗
PubMed1999

Analysis of MHC class II genes in the susceptibility to lupus in New Zealand mice.

Hybrids of New Zealand Black (NZB) and New Zealand White (NZW) mice spontaneously develop a disease similar to human systemic lupus erythematosus. MHC and non-MHC genes contribute to disease susceptibility in this murine model. Multiple studies have shown that the NZW H2z locus is strongly associated with the development of lupus-like disease in these mice. The susceptibility gene(s) within H2z is not known, but different lines of evidence have pointed to class II MHC genes, either H2-E or H2-A (Ez or Az in NZW). Recent studies from our laboratory showed that Ez does not supplant H2z in the contribution to lupus-like disease. In the present work we generated C57BL/10 (B10) mice transgenic for Aaz and Abz genes (designated B10.Az mice) and used a (B10.Az x NZB)F1 x NZB backcross to assess the contributions of Az genes to disease. A subset of backcross mice produced high levels of IgG autoantibodies and developed severe nephritis. However, no autoimmune phenotype was linked to the Az transgenes. Surprisingly, in the same backcross mice, inheritance of H2b from the nonautoimmune B10 strain was strongly linked with both autoantibody production and nephritis. Taken together with our previous Ez studies, the present work calls into question the importance of class II MHC genes for lupus susceptibility in this model and provides new insight into the role of MHC in lupus-like autoimmunity.

Animals↗
PubMed1998

Contributions of Ea(z) and Eb(z) MHC genes to lupus susceptibility in New Zealand mice.

Unlike parental New Zealand Black (NZB) or New Zealand White (NZW) mice, (NZB x NZW)F1 mice exhibit a lupus-like disease characterized by IgG autoantibody production and severe immune complex-mediated nephritis. In studies of the genetic susceptibility to disease in this F1 model, the NZW MHC (H2z) has been strongly linked with the development of disease, and it was hypothesized that class II MHC genes, particularly Ez genes, may underlie this genetic contribution. In the present study, we bred transgenic B6 mice expressing I-Ez or congenic B6 mice carrying H2z with NZB mice and used a backcross analysis to test the hypothesis that Ea(z) and/or Eb(z) genes account for the effect of H2z on disease. The genetic analysis of different backcross combinations showed that unlike mice carrying H2z, mice inheriting Ez transgenes do not demonstrate increased IgG autoantibody production or increased incidence of nephritis. Surprisingly, in the same transgenic backcross mice, inheritance of the endogenous H2b from the B6 strain was strongly linked with the production of IgG autoantibodies, but not with disease. Additional experiments suggested that the level of IgG3 autoantibody production, which is controlled by H2, may be important in the pathogenesis of renal disease. Contributions to autoantibody production were also detected from an NZB locus on distal chromosome 1 (previously named Nba2). Together, these studies provide new insight into the role of MHC in lupus-like autoimmunity.

Animals↗
PubMed2006

One year of smokefree bars and restaurants in New Zealand: impacts and responses.

BACKGROUND: New Zealand introduced a smokefree bars and restaurants policy in December 2004. We reviewed the data available at December 2005 on the main public health, societal and political impacts and responses within New Zealand to the new law. METHODS: Data were collected from publicly available survey reports, and from government departments and interviews. This included data on smoking in bars, attitudes to smokefree bars, bar patronage, socially cued smoking, and perceived rights to smokefree workplaces. RESULTS: The proportion of surveyed bars with smoking occurring decreased from 95% to 3% during July 2004-April 2005. Between 2004 and 2005, public support for smokefree bars rose from 56% to 69%. In the same period, support for the rights of bar workers to have smokefree workplaces rose from 81% to 91%. During the first ten months of the smokefree bars policy, there were only 196 complaints to officials about smoking in the over 9900 licensed premises. The proportion of smokers who reported that they smoked more than normal at bars, nightclubs, casinos and cafés halved between 2004 and 2005 (from 58% to 29%). Seasonally adjusted sales in bars and clubs changed little (0.6% increase) between the first three quarters of 2004 and of 2005, while café and restaurant sales increased by 9.3% in the same period. Both changes continued existing trends. Compared to the same period in 2004, average employment during the first three quarters of 2005 was up 24% for 'pubs, taverns and bars', up 9% for cafés/restaurants, and down 8% for clubs (though employment in 'pubs, taverns and bars' may have been affected by unusually high patronage around a major sports-series). The proportion of bar managers who approved of smokefree bars increased from 44% to 60% between November 2004 and May 2005. Bar managers also reported increased agreement with the rights of bar workers and patrons to smokefree environments. The main reported concerns of the national and regional Hospitality Associations, in 2005, were the perceived negative effects on rural and traditional pubs. CONCLUSION: As in other jurisdictions, the introduction of smokefree bars in New Zealand has had positive overall health protection, economic and social effects; in contrast to the predictions of opponents.

Commerce↗