ABSTRACT This chapter reviews the unique historical experience of public health in Australia and ... more ABSTRACT This chapter reviews the unique historical experience of public health in Australia and New Zealand. It then evaluates their more recent achievements and assesses their likely prospects in rapidly changing regional and global circumstances.
The term e-government describes the use of information and communications technology, particularl... more The term e-government describes the use of information and communications technology, particularly the Internet, for the delivery of public services. As governments invest in e-government, there is only limited knowledge of the extent of public trust in the new electronic modes of delivery; we also know little about whether there is any relationship between trust in government and trust in e-government. This article reports on research designed to probe this issue. Drawing on survey data from Australia and New Zealand, a series of hypotheses are tested pertaining to relationships between public trust in government and e-government, in the use of information and communications technology and trust in e-government, and support for e-government investment and development. Trust in government was found not to be correlated with trust in facets of e-government service provision but was associated with support for e-government investment. More intensive Internet users were more likely to trust e-government services.
Background There is growing interest in the idea of elected members on health service governing b... more Background There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear.
... Norm Baldwin a , Robin Gauld b & Shaun Goldfinch c * Available online: 15 Sep 2011. ... P... more ... Norm Baldwin a , Robin Gauld b & Shaun Goldfinch c * Available online: 15 Sep 2011. ... Profiling the Adopters of E-Government Information and Services. Social Science Computer Review , 24:2: 17288. [CrossRef], [Web of Science ®] View all references; Sanchez et al. 200834. ...
Aims To describe the extent of the dog bite problem in New Zealand for the period 1989 to 2001. M... more Aims To describe the extent of the dog bite problem in New Zealand for the period 1989 to 2001. Methods Fatalities and cases requiring public-hospital treatment identified from the New Zealand Health Information Service databases. Results There was one fatality and 3119 hospitalisations, an average of 240 per year. Those most at risk were males and children under 9 years
To investigate healthcare professional perceptions of local implementation of a national clinical... more To investigate healthcare professional perceptions of local implementation of a national clinical governance policy in New Zealand. Respondent comments written at the end of a national healthcare professional survey designed to assess implementation of core components of the clinical governance policy. The written comments were provided by respondents to a survey distributed to over 41 000 registered healthcare professionals employed in 19 of New Zealand's government-funded District Health Boards. Comments were analysed and categorised within emerging themes. 3205 written comments were received. Five key themes illustrating barriers to clinical governance implementation were found, representing problems with: developing management-clinical relations; clinicians stepping up into clinical governance and leadership activities; interprofessional relations; training needs for governance and leadership; and having insufficient time to get involved. Despite a national policy on clinica...
AbstractÐThis paper considers the involvement and performance in the health sector of the Hong Ko... more AbstractÐThis paper considers the involvement and performance in the health sector of the Hong Kong government prior to and beyond the transfer of sovereignty from Britain to China in July 1997. The paper commences with a historical survey of health services development, which provides insights into why the health system functions in its present haphazard manner. This section culminates by discussing the 1991 establishment of the statutory Hospital Authority which was an attempt to alleviate escalating problems in the administration of hospitals and public health services. Next, the paper surveys the present, discussing, respectively, the roles of government and private service providers, health care outcomes and the contribution of traditional Chinese medicine. Finally, the paper outlines a range of pressing issues which Hong Kong's future policy-makers will need to confront: the organization of the health sector, health ®nancing and the health policy de®cit. In the conclusion, it is posited that there is a need for government to formulate a health policy and to clarify its role in the provision of services. #
This article posits that health is one of the more dif cult areas of public policy making and ser... more This article posits that health is one of the more dif cult areas of public policy making and service provision, owing to a variety of circumstantial and contextual issues. It suggests that advancements in medical practice and organization are not simplifying health policy; along with the changing context of health, they are complicating the processes of policy making and provision. The article discusses a number of trends and emerging issues in public policy philosophy, health care nancing, structures and service delivery. It concludes that the complex context of health care requires approaches to policy making which are participatory and consultative.
ABSTRACT Principal-agent theory has provided a powerful and all-encompassing framework for public... more ABSTRACT Principal-agent theory has provided a powerful and all-encompassing framework for public sector organisation. Its influence in New Zealand since the late-1980s has been particularly strong, despite questions over its appropriateness. This article discusses the case of health information management in New Zealand's health sector which, through the 1990s, endured several policy changes. One constant during this period was reliance on principal-agent theory-inspired organisation. The article illustrates how principal-agent theory failed to create an environment conducive to effective development of health information systems. By the end of the 1990s, when principals wanted collaboration in health care, information systems developed in the preceding competitive period, with no central coordination, were simply inadequate. Based on experiences outlined in the article, four areas are noted in which principal-agent theory may need revision.
The impact of hospital and system restructuring on the quality and pattern of care is an importan... more The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern. To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s. Trend analysis using both tabular and multilevel techniques. Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988-2001. Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate. Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not by reform phase. Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes.
Journal of Health Organisation and Management, 2005
Hong Kong was particularly affected by the 2003 outbreak of Severe Acute Respiratory Syndrome (SA... more Hong Kong was particularly affected by the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). During the epidemic, it seemed as if the Hong Kong government and health system were barely coping, leading to calls of mismanagement and governance incapacity. In the wake of the SARS outbreak, two inquiries were conducted. The purpose of this article is to review the Hong Kong's response to SARS from the perspective of two inquiries. An historical analysis of the institutional arrangements for health care delivery in Hong Kong is undertaken, followed by a chronology of developments in the SARS outbreak. The article then reviews outbreak management and the findings of the two inquiries. Finally, it considers whether the Hong Kong health system can be reformed to manage any future infectious disease epidemic better. Both leadership and coherency were lacking in Hong Kong's response to SARS. These are age-old problems in the Hong Kong health sector. The prospects for mending the health system appear limited, given that leadership and coherency have been consistently absent features of post-1997 governance in Hong Kong. This article reviews events in the immediate period following the SARS outbreak. A future follow-up study of the Hong Kong government and health system's capacity to respond to infectious disease outbreaks would be useful. This article provides a review that will be useful to policymakers and researchers. No other article reviews the Hong Kong health system's SARS response.
Health sector restructuring has been in vogue, but no country has engaged in as much health secto... more Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.
This article discusses events that led up to and the aftermath of New Zealand's radical h... more This article discusses events that led up to and the aftermath of New Zealand's radical health sector restructuring of 1993. It suggests that "big bang" policy change facilitated the introduction of a set of market-oriented ideas describable as a policy prescription. In general, the new system performed poorly, in keeping with problems of market failure endemic in health care. The system was subsequently restructured, and elements of the 1993 structures were repackaged through a series of incremental changes. Based on the New Zealand experience, big bang produces change but not necessarily a predictive model, and the policy prescription has been oversold.
In 2001, the New Zealand government commenced a program to reform the organization of publicly fu... more In 2001, the New Zealand government commenced a program to reform the organization of publicly funded primary care services. While there have been several positive results of this reform, including the reduction of patient co-payments and the extension of the range of primary care services, the government's program was a hastily implemented attempt to place primary care, the delivery of which is dominated by private doctors, under firm state control. It was also an attempt to override preexisting arrangements. As such, the government succeeded in its goal of establishing new primary health organizations (PHOs), but there were also significant unintended consequences. As detailed in this article, these consequences include (1) the creation of a labyrinthine funding and organizational system with a variable capacity to deliver on the government's reform objectives, (2) an increase in the power and scope of preexisting doctor organizations combined with a government unable to wrest control over the setting of patient co-payment levels, and (3) an emerging lack of clarity about future directions for the primary health care sector.
... in spite of the fact that, as noted above, the health sector had moved away from competition.... more ... in spite of the fact that, as noted above, the health sector had moved away from competition. ... allocation and services configuration; and also for a focus on service integration and collaboration. ... now serves as the chief policy adviser, planner and funder of the public health sector ...
International Journal of Public Sector Management, 2003
... restructuring unveiled in 1999, and its antecedents, and details the procedures involved in t... more ... restructuring unveiled in 1999, and its antecedents, and details the procedures involved in the transition from HFA to MOH and DHBs. ... superordinate goals that all concerned parties identify with and can work towards (Beckhard and Harris, 1987; Pattison, 1996; Sherif and Sherif ...
International Journal of Public Administration, 2002
ABSTRACT This paper presents the results of two surveys, conducted in 1993 and 1997, which inquir... more ABSTRACT This paper presents the results of two surveys, conducted in 1993 and 1997, which inquired into the attitudes towards aspects of their immediate and external working environments of New Zealand's senior health officials. The surveys are in the tradition of a growing body of international research which seeks to categorize respondents in terms of their bureaucratic “type.” Where the 1993 survey produced baseline information, the 1997 exercise served as a follow-up. Accordingly, the paper compares various results and discusses shifts in attitudinal orientation and bureaucratic classification. Key findings are that, in 1997, there has been a growth in both the number of “technocrats,” respondents with an aversion to politics but a strong commitment to policy programmes, and in the number of “classical bureaucrats,” respondents, again, with a dislike of politics but, in contrast to technocrats, with a short-term focus and tendency to react to policy problems as they arise. It is concluded that, while restructuring of the New Zealand health sector continues, there is a need to nurture “political bureaucrats:” those who can operate in a politicized environment and who can plan ahead with the participation of the attentive public.
ABSTRACT This chapter reviews the unique historical experience of public health in Australia and ... more ABSTRACT This chapter reviews the unique historical experience of public health in Australia and New Zealand. It then evaluates their more recent achievements and assesses their likely prospects in rapidly changing regional and global circumstances.
The term e-government describes the use of information and communications technology, particularl... more The term e-government describes the use of information and communications technology, particularly the Internet, for the delivery of public services. As governments invest in e-government, there is only limited knowledge of the extent of public trust in the new electronic modes of delivery; we also know little about whether there is any relationship between trust in government and trust in e-government. This article reports on research designed to probe this issue. Drawing on survey data from Australia and New Zealand, a series of hypotheses are tested pertaining to relationships between public trust in government and e-government, in the use of information and communications technology and trust in e-government, and support for e-government investment and development. Trust in government was found not to be correlated with trust in facets of e-government service provision but was associated with support for e-government investment. More intensive Internet users were more likely to trust e-government services.
Background There is growing interest in the idea of elected members on health service governing b... more Background There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear.
... Norm Baldwin a , Robin Gauld b & Shaun Goldfinch c * Available online: 15 Sep 2011. ... P... more ... Norm Baldwin a , Robin Gauld b & Shaun Goldfinch c * Available online: 15 Sep 2011. ... Profiling the Adopters of E-Government Information and Services. Social Science Computer Review , 24:2: 17288. [CrossRef], [Web of Science ®] View all references; Sanchez et al. 200834. ...
Aims To describe the extent of the dog bite problem in New Zealand for the period 1989 to 2001. M... more Aims To describe the extent of the dog bite problem in New Zealand for the period 1989 to 2001. Methods Fatalities and cases requiring public-hospital treatment identified from the New Zealand Health Information Service databases. Results There was one fatality and 3119 hospitalisations, an average of 240 per year. Those most at risk were males and children under 9 years
To investigate healthcare professional perceptions of local implementation of a national clinical... more To investigate healthcare professional perceptions of local implementation of a national clinical governance policy in New Zealand. Respondent comments written at the end of a national healthcare professional survey designed to assess implementation of core components of the clinical governance policy. The written comments were provided by respondents to a survey distributed to over 41 000 registered healthcare professionals employed in 19 of New Zealand's government-funded District Health Boards. Comments were analysed and categorised within emerging themes. 3205 written comments were received. Five key themes illustrating barriers to clinical governance implementation were found, representing problems with: developing management-clinical relations; clinicians stepping up into clinical governance and leadership activities; interprofessional relations; training needs for governance and leadership; and having insufficient time to get involved. Despite a national policy on clinica...
AbstractÐThis paper considers the involvement and performance in the health sector of the Hong Ko... more AbstractÐThis paper considers the involvement and performance in the health sector of the Hong Kong government prior to and beyond the transfer of sovereignty from Britain to China in July 1997. The paper commences with a historical survey of health services development, which provides insights into why the health system functions in its present haphazard manner. This section culminates by discussing the 1991 establishment of the statutory Hospital Authority which was an attempt to alleviate escalating problems in the administration of hospitals and public health services. Next, the paper surveys the present, discussing, respectively, the roles of government and private service providers, health care outcomes and the contribution of traditional Chinese medicine. Finally, the paper outlines a range of pressing issues which Hong Kong's future policy-makers will need to confront: the organization of the health sector, health ®nancing and the health policy de®cit. In the conclusion, it is posited that there is a need for government to formulate a health policy and to clarify its role in the provision of services. #
This article posits that health is one of the more dif cult areas of public policy making and ser... more This article posits that health is one of the more dif cult areas of public policy making and service provision, owing to a variety of circumstantial and contextual issues. It suggests that advancements in medical practice and organization are not simplifying health policy; along with the changing context of health, they are complicating the processes of policy making and provision. The article discusses a number of trends and emerging issues in public policy philosophy, health care nancing, structures and service delivery. It concludes that the complex context of health care requires approaches to policy making which are participatory and consultative.
ABSTRACT Principal-agent theory has provided a powerful and all-encompassing framework for public... more ABSTRACT Principal-agent theory has provided a powerful and all-encompassing framework for public sector organisation. Its influence in New Zealand since the late-1980s has been particularly strong, despite questions over its appropriateness. This article discusses the case of health information management in New Zealand's health sector which, through the 1990s, endured several policy changes. One constant during this period was reliance on principal-agent theory-inspired organisation. The article illustrates how principal-agent theory failed to create an environment conducive to effective development of health information systems. By the end of the 1990s, when principals wanted collaboration in health care, information systems developed in the preceding competitive period, with no central coordination, were simply inadequate. Based on experiences outlined in the article, four areas are noted in which principal-agent theory may need revision.
The impact of hospital and system restructuring on the quality and pattern of care is an importan... more The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern. To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s. Trend analysis using both tabular and multilevel techniques. Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988-2001. Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate. Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not by reform phase. Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes.
Journal of Health Organisation and Management, 2005
Hong Kong was particularly affected by the 2003 outbreak of Severe Acute Respiratory Syndrome (SA... more Hong Kong was particularly affected by the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). During the epidemic, it seemed as if the Hong Kong government and health system were barely coping, leading to calls of mismanagement and governance incapacity. In the wake of the SARS outbreak, two inquiries were conducted. The purpose of this article is to review the Hong Kong's response to SARS from the perspective of two inquiries. An historical analysis of the institutional arrangements for health care delivery in Hong Kong is undertaken, followed by a chronology of developments in the SARS outbreak. The article then reviews outbreak management and the findings of the two inquiries. Finally, it considers whether the Hong Kong health system can be reformed to manage any future infectious disease epidemic better. Both leadership and coherency were lacking in Hong Kong's response to SARS. These are age-old problems in the Hong Kong health sector. The prospects for mending the health system appear limited, given that leadership and coherency have been consistently absent features of post-1997 governance in Hong Kong. This article reviews events in the immediate period following the SARS outbreak. A future follow-up study of the Hong Kong government and health system's capacity to respond to infectious disease outbreaks would be useful. This article provides a review that will be useful to policymakers and researchers. No other article reviews the Hong Kong health system's SARS response.
Health sector restructuring has been in vogue, but no country has engaged in as much health secto... more Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.
This article discusses events that led up to and the aftermath of New Zealand's radical h... more This article discusses events that led up to and the aftermath of New Zealand's radical health sector restructuring of 1993. It suggests that "big bang" policy change facilitated the introduction of a set of market-oriented ideas describable as a policy prescription. In general, the new system performed poorly, in keeping with problems of market failure endemic in health care. The system was subsequently restructured, and elements of the 1993 structures were repackaged through a series of incremental changes. Based on the New Zealand experience, big bang produces change but not necessarily a predictive model, and the policy prescription has been oversold.
In 2001, the New Zealand government commenced a program to reform the organization of publicly fu... more In 2001, the New Zealand government commenced a program to reform the organization of publicly funded primary care services. While there have been several positive results of this reform, including the reduction of patient co-payments and the extension of the range of primary care services, the government's program was a hastily implemented attempt to place primary care, the delivery of which is dominated by private doctors, under firm state control. It was also an attempt to override preexisting arrangements. As such, the government succeeded in its goal of establishing new primary health organizations (PHOs), but there were also significant unintended consequences. As detailed in this article, these consequences include (1) the creation of a labyrinthine funding and organizational system with a variable capacity to deliver on the government's reform objectives, (2) an increase in the power and scope of preexisting doctor organizations combined with a government unable to wrest control over the setting of patient co-payment levels, and (3) an emerging lack of clarity about future directions for the primary health care sector.
... in spite of the fact that, as noted above, the health sector had moved away from competition.... more ... in spite of the fact that, as noted above, the health sector had moved away from competition. ... allocation and services configuration; and also for a focus on service integration and collaboration. ... now serves as the chief policy adviser, planner and funder of the public health sector ...
International Journal of Public Sector Management, 2003
... restructuring unveiled in 1999, and its antecedents, and details the procedures involved in t... more ... restructuring unveiled in 1999, and its antecedents, and details the procedures involved in the transition from HFA to MOH and DHBs. ... superordinate goals that all concerned parties identify with and can work towards (Beckhard and Harris, 1987; Pattison, 1996; Sherif and Sherif ...
International Journal of Public Administration, 2002
ABSTRACT This paper presents the results of two surveys, conducted in 1993 and 1997, which inquir... more ABSTRACT This paper presents the results of two surveys, conducted in 1993 and 1997, which inquired into the attitudes towards aspects of their immediate and external working environments of New Zealand's senior health officials. The surveys are in the tradition of a growing body of international research which seeks to categorize respondents in terms of their bureaucratic “type.” Where the 1993 survey produced baseline information, the 1997 exercise served as a follow-up. Accordingly, the paper compares various results and discusses shifts in attitudinal orientation and bureaucratic classification. Key findings are that, in 1997, there has been a growth in both the number of “technocrats,” respondents with an aversion to politics but a strong commitment to policy programmes, and in the number of “classical bureaucrats,” respondents, again, with a dislike of politics but, in contrast to technocrats, with a short-term focus and tendency to react to policy problems as they arise. It is concluded that, while restructuring of the New Zealand health sector continues, there is a need to nurture “political bureaucrats:” those who can operate in a politicized environment and who can plan ahead with the participation of the attentive public.
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Papers by Robin Gauld