Did the sweeping health reforms in New Zealand truly deliver on their promise? Despite some health indicators showing improvement three years after the reforms, access to primary care remains a significant concern, according to experts Arshad Ali and Ehtasham Ghauri. When the former Labour-led government introduced the Pae Ora (Healthy Futures) reforms in 2022, they were hailed as the most significant overhaul of New Zealand's health system in decades. The reforms aimed to address chronic fragmentation, narrow postcode-based care gaps, and long-standing health inequities. However, the picture is not as rosy as initially presented. Our recent analysis reveals a mixed outcome. While national coordination has improved crisis response and planning, everyday access to primary care, particularly GP appointments, has become more challenging for many. The shift in political direction has also underscored a critical lesson: structural reform can enhance capacity, but without a durable political consensus and clear accountability, any equity gains are fragile. What exactly did the reforms change? The reforms replaced 20 district health boards with a single national organization, Health New Zealand, and established a Māori Health Authority to embed Treaty-based governance and commissioning. This was a significant milestone in New Zealand, recognizing Māori leadership in the health system and the Te Tiriti partnership. The goal was straightforward: a more centralized system for better planning, faster crisis response, and more consistent services nationwide. In some respects, the reforms have been successful. Central coordination has strengthened winter planning, workforce pay equity, procurement, and the ability to move patients and resources across regions during periods of pressure. During major weather events and seasonal surges, such as Cyclone Gabrielle in 2023, the health system has functioned better as a unified, coordinated entity rather than a collection of disconnected local services. However, these improvements have not translated into better access to everyday primary care, creating a gap that is now a central concern for the public. General practice has become the primary test of the reforms' success, and the 2024 decision to dismantle the Māori Health Authority has further stressed the system's resilience. According to the 2025 Health Quality & Safety Commission survey, around one in five adults could not get care from their regular GP or nurse when needed, mainly due to long waits, staff shortages, or clinic closures. Delays at the primary care level push more people into emergency departments, increasing hospital pressure. Low-income groups, especially Māori and Pacific communities, are particularly affected, reflecting the ongoing inequities the reforms aimed to address. While some health indicators have improved after the reforms, access to primary care remains uneven, with affordability and availability determining who receives timely treatment. These figures highlight GP access as a key indicator of the system's performance. More specifically, this pattern exposes a critical limitation of the reforms: centralization can improve coordination, but it does not guarantee accessibility, affordability, or a sustainable funding model for general practice. In other words, the levers that shape people's everyday experience of the system were never fully addressed. Why GP access remains the real test These issues are largely outside the structural changes of the 2022 reforms but significantly impact how people experience the health system daily. Equity was meant to be a central feature of the reforms, particularly through the establishment of the Māori Health Authority. The objective was to empower Māori people in health policy-making, commissioning services, and shaping their priorities. However, the decision to disestablish the Māori Health Authority in 2024 highlighted a core challenge in New Zealand's health reforms. Supporters argue that a single system improves efficiency and clarity, while critics argue it shows equity was never securely embedded but remained politically contingent. The Waitangi Tribunal found that the Crown failed to meet its Treaty obligations in the way the authority was revoked. Regardless of political stance, the removal of this authority exposes a deeper problem: reforms based on contested governance, without broad political backing, are always at risk of being reversed. Consequently, the change of government has exposed the fragility of reform when it lacks bipartisan support and durable accountability mechanisms. When governance arrangements shift with each election cycle, continuity suffers, and so does public trust. None of this means the 2022 reforms were misguided. They responded to real and well-documented problems. The pre-reform system was more fragmented, inconsistent, and often confusing for patients and providers. Centralization has reduced duplication and improved national oversight in ways that were difficult under the old model. However, the past three years show that structural reform alone does not guarantee equity or access. Health systems transform slowly, and outcomes are shaped more by funding, workforce capacity, incentives, and political stability than by organizational charts. For most New Zealanders, the success of the reforms will not be judged by how well agencies align at the center but by whether they can see a GP when they need one, afford that visit, and avoid ending up in the hospital as a result. On that measure, the reforms remain unfinished, and their future now depends as much on politics as on policy. Author Arshad Ali is a Researcher at the University of Otago; Author Ehtasham Ghauri is a Principal Lecturer at the University of Otago. The article was republished from The Conversation (https://theconversation.com/did-nzs-sweeping-health-reforms-deliver-on-their-promise-3-years-on-the-verdict-is-mixed-272262) under a Creative Commons license.
