Did New Zealand's ambitious health reforms live up to their grand vision? Three years later, the answer is a nuanced one. While some health metrics have shown progress, the promise of equitable access to primary care remains unfulfilled, say experts Arshad Ali and Ehtasham Ghauri.
In 2022, the Labour-led government unveiled the Pae Ora reforms, a bold initiative to overhaul the nation's health system. The goal was to address long-standing health disparities and create a more cohesive, responsive healthcare network. But has this vision become a reality?
The reforms, a significant milestone, replaced district health boards with a centralized Health New Zealand and established a Māori Health Authority. This was a recognition of Māori leadership and partnership in healthcare. The idea was simple: centralization would improve planning, crisis response, and consistency of services.
And indeed, there have been some successes. Central coordination has enhanced winter preparedness, workforce pay equity, and the ability to manage resources during crises. The health system has become more unified in its response to major events, like Cyclone Gabrielle in 2023.
However, these improvements have not translated into better access to primary care. This gap is now a major public concern. General practice has become the litmus test of the reforms' effectiveness, and the decision to disband the Māori Health Authority in 2024 has further tested the system's resilience.
The 2025 Health Quality & Safety Commission survey revealed that one in five adults struggled to access their regular GP or nurse when needed. This was largely due to long waits, staff shortages, and clinic closures. This lack of access pushes more people into emergency departments, increasing hospital strain, with low-income groups and Māori and Pacific communities disproportionately affected.
So, what went wrong? The reforms focused on structural changes, but they failed to address the underlying issues that impact people's daily experiences with the health system. Equity, a central tenet of the reforms, was not fully realized. The disestablishment of the Māori Health Authority in 2024 highlighted this core challenge.
Supporters of the single system argue for efficiency and clarity, while critics point to the lack of secure embedding of equity, which remained politically contingent. The Waitangi Tribunal found the Crown's revocation of the authority to be a breach of Treaty obligations.
The change in government has exposed the fragility of reforms without bipartisan support and durable accountability. When governance shifts with each election, continuity and public trust suffer. The 2022 reforms, though well-intentioned, have shown that structural changes alone do not guarantee equitable access or outcomes.
Health systems evolve slowly, and outcomes are shaped by funding, workforce, incentives, and political stability, not just organizational structures. For New Zealanders, the success of these reforms will be judged by their ability to access affordable, timely primary care without resorting to emergency departments.
The verdict on the Pae Ora reforms is still out, and their future is tied as much to politics as it is to policy. The journey towards a healthier, more equitable New Zealand continues, and the conversation around these reforms is far from over.
