The political economy of health care in New Zealand : A comparative analysis

This thesis develops a comprehensive theoretical framework on which to analyse the political economy of health care. It brings together the major political, social and economic forces affecting health care in New Zealand. It also places the New Zealand health care system within a comparative context, and in particular examines the political economy of health care in Singapore, Taiwan, South Korea and Japan. The study examines the contemporary New Zealand health care system against a backdrop of socio-economic restructuring and the hegemony of neo-liberalism. It deals with major issues of power and control in relation to factors such as social class, wealth and income, ownership and business influence. Cutting across all these issues are gender, ethnic and resource inequalities. It is argued that the socio-economic determinants of health status are not receiving the attention they deserve. Economic changes over the past decade have served to increase rather than diminish disparities in the distribution of wealth and income in New Zealand society. There are no signs of this situation abating; indeed it is more likely to get worse. The findings show that many of the same business people and outside consultants who are dominant in shaping the New Zealand economy also dominate the health policy-making process. It is argued that the overriding presence of business people on the decision-making bodies of the health institutions serve to legitimise, reproduce and strengthen free market principles. In Singapore, Taiwan, South Korea and Japan, however, the free market has not been accepted unconditionally as a matter of dogma, and the state plays a major role in the economy. It is suggested that these countries may offer valuable policy alternatives or lessons for New Zealand as it enters the new political environment