Commissioning in New Zealand: learning from the past and present.

Over the past 25 years, New Zealand has had significant experience with two very different approaches to commissioning health and disability support services. The first is the purchaser-provider split model adopted during the 1990s. The second is the approach that replaced it in 2001, the District Health Board model, which is still in place today. Although the New Zealand health system has several desirable characteristics and recent developments in commissioning arrangements are improvements on earlier approaches, the system is slow at reorienting care, particularly towards primary healthcare services. Alternative arrangements have strengths and weaknesses but the current 'alliancing' approach in New Zealand needs time to consolidate and demonstrate whether it can deliver before those alternatives are seriously considered.