Aotearoa Health System: Hierarchical Governance Analysis

Analysis

The Aotearoa health system is predominately based on a hierarchical governance in which elements of this coordination mechanism are seen in the BSP and NBSP. Hierarchical governance draws on authority and power to steer and influence the actions of actors in the interest of the state.This shapes policy, by marketing primary health care services and the delivery of services, through the policy networks (Bouckaert, Peters, & Verhoest, 2010; Tenbensel, Mays, et al., 2011). It is suggested that hierarchy coordination is a form of control, in which state has the ability to alter actions of organisations that they may not have taken. Aspects of a hierarchical governance are further emphasised on the MoH’s website in which portrays an outline

In particular, ProCare’s role was central to the outputs and the process of the BSP, such as enhanced communication between key actors and promoted the BSP to citizens. As stated previously, PHOs need to establish a stronger position on their services direction, for example, a network of providers or purchasers of primary health care services. If the former, a network as a form of coordination mechanism, then PHOs, in theory, have the capacity to work closely with DHBs to deliver primary health care that is in line with the PHO services agreement. However, if the latter role is desired, a market as a form of coordination mechanism, thus an examination of PHOs role and governance arrangement will be required to ensure PHO have the capacity and capability to achieve policy objectives (Cordery, 2008; NZ Doctor, 2015; HomeCare Medical,

Networks are cooperative interactions between actors around specific issues of policy, such as the BSP, and is based on mutual trust, independent responsibilities, and reciprocity. Network governance often imposes horizontal coordination, which is built upon negotiation, and bargaining among the actors, rather than vertical authoritative approach (Bouckaert, Peters, & Verhoest, 2010). An example of network governance is particularly apparent in the implementation phase of the NBSP in the Hutt Valley and Wairarapa DHBs (National Screening Unit, 2017b). These DHBs were chosen to due to their past history of working together and a strong focus on primary health care. Network governance offers a diversity of stakeholders, and perspectives surrounding the goals, and processes of the NBSP (Head,