Presentation to Macrogroup Seminar, Friday 21 November, 2025; there is a PowerPoint that goes with this presentation. Available on request. Social Investment Analysis is another example of project evaluation where economists use Cost-Benefit Analysis. By the 1960s New Zealand was using CBA in the evaluation of irrigation and transport projects when, for various reasons, market…
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Presentation to Wellington Macrogroup Seminar on Debt policy. 7 November 2025; there is a PowerPoint that goes with this presentation. Available on request. This paper argues that we should focus fiscal policy on net worth more than we do. The current obsession with debt ignores the difference between borrowing for investment purposes and borrowing for…
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A physician’s memoir describing a successful research program leads to pondering about research funding strategies. A few years back, I was, in effect, commissioned to review the development possibilities of a local biotech industry, especially one for creating new pharmaceuticals. At the time, it was fashionable in every regional plan – anywhere in the world…
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What can you do when you have hit your borrowing limit and still want to spend? One option is to cut back on maintenance of your capital – say, to delay repainting the house or keeping the car in tip-top condition. The government does the same. Hence our three water systems leaking, polluting and flooding;…
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Circulated to colleagues The Minister of Health has announced that he expects Health New Zealand to take out ten-year contracts with private health providers to deliver surgery. This is structural outsourcing; it is a form of privatisation (although, no doubt the minister would deny this claim). Whether such long-term outsourcing is efficient is a complicated…
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Post 8 May 2025 Dr Alan Gray’s achievements were never officially recognised by any royal honour or honorary doctorate. Extraordinary really, given the length and weight of his list of achievements. They include being central to the establishment and administration of two palliative care units: Mary Potter Hospice in Wellington and the King Faisal Specialist…
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This note is work in progress which I circulated to some colleagues. This paper is about the importance of culture in the healthcare system. It argues that the changes to it should focus on enhancing a patient-centred approach by paying more attention to the culture of the medical professions. Without doing so, the changes in…
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This note is work in progress which I circulated to some colleagues. One of the management learnings from the 1970s and 1980s is that if managers were given multiple objectives they pursued none of them well. They are likely to prioritise some objectives over others even though they may not be the most important to…
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Published by AHAA (Apologies for the tabulation presentations.) Introduction By way of background, doing some unrelated work I came across some international data on the healthcare sector which seemed to contradict my, and the conventional wisdom’s, view of the healthcare sector. Broadly, it is that the sector has been underfunded. That is not what the…
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By international standards the New Zealand healthcare system appears satisfactory – certainly no worse generally than average. Yet it is undergoing another redisorganisation. While doing some unrelated work, I came across some international data on the healthcare sector which seemed to contradict my – and the conventional wisdom’s – view of the healthcare sector. Broadly,…
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This was a note I prepared for myself International experience provides very little guidance to the problem of designing an effective health system; there is little structural convergence between the health systems of affluent countries on the supply-side. One almost universal exception to this pessimistic conclusion is that the funding of a health system needs…
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Healthcare sector management needs to break away from its obsession with financial information and focus on funding for access. Health New Zealand recently ‘proactively released’ 454 pages about its financial performance to July 2024. Here is a letter it did not release. Hon Dr Shane Reti, Minister of Health. Dear Minister. We have been deluging…
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Comment to Fabian Society at the National Theatre Alive Film of ‘NYE’: 13 September, 2024 You will hear I have some voice limitations. It is the result of successful surgery on my larynx. When I reflect on what happened, I am struck at the quality and the expertise of the healthcare professionals who treated me…
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The claim that there are currently 14 layers of management at Health New Zealand, raises wider issues of how we organise systems. I want to write a column about current proposals to redisorganise Health New Zealand but, frustratingly, the Coalition Government has not released evidence of its claim that the successor to the District Health…
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If you don’t understand how things work you make foolish mistakes. To explain how the government got into its cancer drugs muddle, we need to explain first how New Zealand’s pharmaceutical purchasing system works. There is a parallel between Pharmac and the Reserve Bank of New Zealand. The Government sets the monetary policy framework with…
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The Government says it will give localities more control over healthcare decisions. But how? New Zealand’s political reflex is that any problem can be resolved by further centralisation. Students will be officially banned from having cell phones at school from Term 2. The decision could have been left to individual schools. Each knows a lot…
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Public policy towards tobacco consumption remains politically sensitive. In 1983, a young researcher was told by a medium-level Treasury official that Treasury policy was to abandon excise duties on tobacco. The senior Treasury economist that I consulted, famed for his commonsense, snorted ‘we need the money’. He explained that no-excise-duty was the ambition of a…
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Note written for circulation January 2024 In 2023 the New Zealand Health System was further centralised. As usual, the reasons given for the redisorganisation were unclear, thin and unconvincing. There have been no immediate benefits evident from the new structure; experience suggests that if there are any, they will take time to manifest themselves. Downsides…
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Did you think the incoming government promised to extend bowel screening to 50-59 year olds? The promise was more limited – and more feasible. National’s Manifesto promised: Bowel cancer is the second highest cause of cancer death in New Zealand, while we have one of the highest rates of bowel cancer in the world. More…
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It is the professionalism – competence and integrity – of the doctors, nurses and technicians who provide the care which obscures the managerial failure. The column-blog, Otaihanga Second Opinion is compulsory reading for anyone interested in the health sector. It is written by Ian Powell, who was Executive Director of the Association of Salaried Medical…
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