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Abstract
Two very different policy regimes, one based around markets and the other around local democracy, have
characterized health policy in New Zealand since 1991. Market-oriented reforms in the first half of the
1990s explicitly sought to de-politicize the health sector by ending a long tradition of elected local health
boards and were promoted as offering greater consumer power. Instead, Government fostered a strong
reaction among voters towards more public control of the health sector. A new reform law enacted in
2000 has assertively returned local voter control of the hospital sector and promises to strengthen public
participation in decision-making.
The reactions of voters have also derailed market-oriented health care reforms in other countries.
However, in many countries voters have not exhibited the same backlash towards economic reforms. Five
factors are considered important for understanding the shift between market and democratic policy
models, and the rejection of market models in health care more generally: (1) the difficulty of reforming
health care after reforming the economy (2) public support for the notion of health care as a social rather
than marketable commodity (3) signaling effects from the range and vehemence of market reform
opponents and sympathy with professional groups; (4) negative understandings of the effects of
competition-oriented health care reform, and (5) no favorable models for market-based health care able to
justify reforms.
Convention