I would vote for any party that ran on a platform of removing the DHBs and centralizing health. DHBs are just little kingdom building exercises that waste money by replicating services across regions. An example is DHBs choosing different ICT systems from each other so there is no way information can be easily shared and no savings through bulk purchase. Why each DHB needs a full ICT team with their own data centers etc is beyond me for a country of <5 Million.
This would also get rid of all of these "elected" board members.
Whilst it's a good idea in theory, it's not that simple.
- Who will run your nationwide system? The Ministry of Health is pretty much incompetent. If you get a private company to run the data centre, they'll siphon money out of the MoH so fast there'll be a vacuum.
- The DHBs aren't kingdom-building exercises; they were set up as part of Roger Douglas's nuttiness in the 1980s; they were supposed to drive costs down by competing with each other for contracts. Hence what had been a slightly coherent system fell into disarray. Getting back to a single unified system will be extremely difficult (i.e. expensive and slow).
- The one good thing out of the split-up was that DHBs could get systems that matched their scale; for example, smaller DHBs don't provide oncology services, so don't need the systems that support that. You would lose those efficiencies (such as they are).
- Regionalisation is well underway already, with many DHBs sharing data with others in their region, although not yet nationally (e.g. the big 3 Auckland DHBs have been sharing clinical information for about 10 years). But the regional data centres are (surprisingly?? I don't think so) vastly more expensive than the DHB-based ones.
- Most DHBs don't have a "full ICT team". They are run with the minimal amount of staff, and sometimes less.
- I don't think NZ is big enough to make a "bulk purchase".
- The MoH's eccentricities are a major contributor to the issues that DHBs face (e.g. setting loony targets).
- Underfunding (and poor decision-making at DHB/Executive level) has led to corner-cutting and deferred maintenance and understaffing and underinvestment in technology; these chickens are coming home to roost now.
- One of the interesting outcomes of the Kaikoura earthquake was the incapacitation of Kaikoura hospital; there were *six* breaks in the fibre between them and Christchurch, where their data centre is. Do you really want the data processing for a major hospital to be done elsewhere?
Any party that ran on a platform of removing the DHBs and centralizing health would be serious head-in-the-sand material.