District health boards (DHBs) in New Zealand are organisations established by the New Zealand Public Health and Disability Act 2000, responsible for ensuring the provision of health and disability services to populations within a defined geographical area. They have existed since 1 January 2001 when the Act came into force. There are 20 DHBs (fifteen in the North Island and five in the South Island). Initially there were 21 DHBs, and this was reduced to the current 20 organisations in 2010. DHBs receive public funding from the Ministry of Health on behalf of the Crown, based on a formula which takes into account the total number, age, socio-economic status and ethnic mix of their population. DHBs are governed by boards, which are partially elected (as part of the triennial local elections) and partially appointed by the Minister of Health.
Contents
History
District health boards were first introduced as an idea in the 1970s in the Green and White Paper suggested by the then Labour government. This was part of a plan to nationalise primary health care as the Social Security Act of 1938 had originally intended. Labour subsequently lost the election to Robert Muldoon's National Party in the 1975 election. Muldoon's government chose however to slowly implement these reforms in trial "area health boards", which can be seen as early predecessors of the district health boards.
The more direct predecessors were the Crown health enterprises (CHEs) and subsequent Hospital and Health Services (HHS) management structures of the 1990s; these were responsible for managing the hospitals under business ethos, albeit, with the expectation that the former would return a profit to the shareholders (i.e. the government).
In the 1990s "regional health authorities" (RHAs) were formed. These RHAs were amalgamated in 1997 to form the Health Funding Authority (HFA). The election of the Labour-Alliance government in the 1999 election saw the New Zealand Public Health and Disability Act 2000 passed by parliament, this led to the merging of the HFA with the Ministry of Health. Part of the HFA's funding capacity combined with the hospital management elements of the Hospital and Health Services board to form the DHBs.
From their creation until 1 May 2010, there were 21 DHBs. At that date, Otago DHB and Southland DHB amalgamated their boards to form the new Southern DHB.
Organisation
The district health boards are given a set of objectives by the Ministry of Health, but have a degree of autonomy in how they choose to achieve these. In contrast to their predecessors, the regional health authorities, the DHBs are non-profit providers. The performance of individual DHBs is monitored by the DHB Funding and Performance Directorate. DHBs provide funding to primary health organisations (PHOs).
The DHBs are governed by boards, which consist of up to eleven members: seven elected by the public every three years, and up to four appointed by the Government's Minister of Health. From 1 January 2001, the boards were made up of appointed members only. The first elected members were chosen in the 13 October 2001 local elections. The government states that these appointments are to balance the board's expertise as deemed necessary. Voting for public-elected DHB board members occurs through the single transferable vote system, and elections take place at the same time as local body elections.
Taranaki and Wairarapa District Health Boards maintain their own ambulance services, with St John and the Wellington Free Ambulance covering the rest of the country.
On 1 May 2010, the Otago and Southland DHBs were merged to form a new Southern DHB, with elected members coming from two constituencies, Otago and Southland, and the remainder, appointed members of the Minister of Health, with the change taking effect from the 2010 local body elections. From 1 July 2010, a unified primary health organisation has covered the entire new Southern DHB region with PHO centres in Alexandra, Dunedin and Invercargill with the mandate of providing PHO resources and services, replacing the previous nine PHOs.
Locations
There are 20 DHBs, organised around geographical areas, of varying population sizes, though they are not coterminous with the Regions of New Zealand: