| Abstract: | The relationship between public health and clinical medicinehas been the subject of international debate. In New Zealandsuccessive restructurings of the health sector have seen significantchanges in this relationship and the status of public health.The paper traces these changes over a decade of public sectorrestructuring (1984–1993) and shows how public healthpolicy and the purchasing and delivery of public health serviceshave been subject to integration, deintegration and reintegrationwith clinical and treatment services. Some advantages flowedfrom integrating policy, purchasing and delivery, includinga comprehensive approach to tackling problems through nationalhealth goals and targets. On the other hand, there is evidencethat public health was financially disadvantaged by this association.A separate public health structure, set up in 1992 and led byan independent Public Health Commission, brought some benefits.These included a specific budget and a high profile for publichealth. It also created tensions between competing policy agencies,a fragmented purchasing system for public health and exposedpublic health to political interference. This led to the abolitionof the Commission in 1995 and the reintegration of policy makingat the national level and purchasing at the regional level.At the end of 1996 a new coalition government formally abandonedthe commercial elements of its predecessor's health reforms.The new policy requires the main providers of hospital and relatedservices, which continue to include public health, to focuson health gains for their defined populations. With the integrationof policy and purchasing this should lead to the promotion ofbetter integration at the service delivery level. |
