Defining core health services: the New Zealand experience

The New Zealand health service has been extensively changed over the past four years, with the introduction of four new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a "core" and no list, either positive (inclusions) or negative (exclusions), has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scarce resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need.