DHBs... (as opposed to admin and red tape, still can't figure out why we need 15 lots of administration of a population of only 4.5 million).
It's Public Service, so it has to be accountable, so there has to be red tape. Everything has to be recorded, so that if someone investigates in 20 years time, the information will be available. But that constant scrutiny has made the whole system super cautious; I've never worked anywhere as change-averse or commitee-loaded as a DHB.
To answer your question about why so many... (it's 23 btw, not 15)... that was the brainchild of Rogernomics. DHBs grew out of Crown Health Enterprises, which were supposed to compete with each other to encourage efficiency. And there was 2 sets of administrations in each DHB, the "funder" which wrote contracts and the "provider" which ran hospitals. Fortunately this lunacy has been gradually worked out of the system. Another aspect was that each CHE/DHB was free to set up their own IT systems, so there's probably a dozen different incompatible clinical records systems in use, let alone accounting, payroll, etc, etc. The DHBs have been working on overcoming this, but getting 23 DHBs to agree on anything is impossible. And the MoH is completely hopeless, so no leadership there. However most "regions" of about 5-6 DHBs each have systems to share clinical information.
I believe that Labour has some kind of plan to reform NZ's health system, but we'll have to wait to see what that is.
District health boards or area health boards existed before rogernomics with local representation on them.
In the competition is always good that led to the Crown Health enterprises and the idea that hospitals would compete with each other which was a nonsense. In chch the geriatric hospital was a different CHE than the main hospital in town with separate IT systems, pathology systems.
It was a XXXX stupid system (personal experience) The geriatricians from the rehab hospital would come to chch hospital to offer consultation services and take over patients who had been admitted with strokes and frailty (the geriatric hospital had no acute admission service) and transfer them 15 km away. The lab results were on different competing computer systems. The xray and CT were on a different systems. Then after their stay and discharge some invariably needed to be readmitted which happened back to the main hospital where they had different systems so it was very annoying because all the information from the rehabilitation phase wasnt on the chch system etc.
Over the course of about 8 years we went from 4 contracting groups which contracted to the CHEs to One contracting group to the same CHEs. The only thing that changed were the logos on the managerial chairs. The doctors, nurses and other staff anf the buildings stayed the same...
Then politicians wanting to be seen to do something proposed a return to DHBs with local boards so feels like we are back to where we started.