District health boards could be in for a major shake-up as the government looks to cut back on bureaucracy and improve access to health care services.
Health Minister David Clark has today announced a broad review into health care inequities, saying the government wanted to future-proof health and disability services.
"We need to face up to the fact that our health system does not deliver equally well for all," Mr Clark said.
"We know our Māori and Pacific peoples have worse health outcomes and shorter lives. That is something we simply cannot accept."
He wanted to see more service sharing and less bureaucracy in the sector.
"That will necessarily mean some change - the extent of that change will depend upon what the review finds in terms of striking the balance between local responsiveness and ensuring we have an efficient delivery system ... that's responsive to the needs of the New Zealand public."
Mr Clark said the review, which would have a 30-year outlook, would focus on primary and community-based care, to help take pressure off hospitals and specialist services.
Nelson-Marlborough community paediatrician Nick Baker said the review was an opportunity to do things better.
"Often we tend to have those who need most, sometimes get least.
"We need to look at our ethnic disparities and our social disparities," he said.
"In the area of child health a lot of conditions vary almost in a predictable way in the conditions in which children are being raised - diseases of deprivation."
Colorado Health Institute vice-president Amy Downs last year wrote a report into New Zealand's Primary Health Care services that recommended cutting the number of DHBs to between four and six to simplify the system.
"You can have people geographically very close with very different access to care and if you had fewer DHBs, you'd have the chief executives of those DHBs thinking systemically over large geographic regions," she said today.
Streamlining DHBs would not only cut back on administration costs, it would also create a far more efficient system.
"You've got all those chief executives - you really stretch the talent pool in a country the size of New Zealand."
The review would be chaired by Heather Simpson, who served as former Prime Minister Helen Clark's chief of staff for nine years.
An interim report will be completed by next July with the final version due in January 2020.