Timeline: The evolution of New Zealand’s public health system – Stuff.co.nz

As the findings of the $9.5 million review of the country's health and disability system led by panel chairwoman Heather Simpson are released on Tuesday, Stuff casts a microscope over the events that have shaped our health system over the past half-century.

New Zealand has undergone four previous public health transformations since the early 1980s, each bringing with it a new set of organisations and structures to fund and deliver health services to the community.

The first was the establishment of Area Health Boards in 1983, followed by the Regional Health Authorities and Crown Health Enterprises (1993-1997), and Health Funding Authority and Hospital and Health Services (1998-2001).

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The number of district health boards could be drastically cut following recommendations in a new report issued on Tuesday.

Eventually, this led to the introduction of 21 District Health Boards (DHBs) in 2001.

READ MORE:* Halve number of DHBs, drop elected boards: sweeping health system reform plan accepted by Govt* Elected board members and DHBs to merge in health system shake-up* DHBs cut mental health funding by $55m; health spending falling overall - union

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Health Minister David Clark wants to cut the number of district health boards, in line with a suite of recommendations made in a major review of the health and disability sector published on Tuesday.

HEALTH SECTOR CHANGES - KEY DATES

1983: 14 Area Health Boards (AHBs) were formed between 1983 and 1989, including locally-elected and appointed board members. An early version of population-based funding was put together to determine funding for AHBs.

1984: Mori health was identified as a health priority by the Ministry of Health.

1988: The Mason Report was published outlining problems dogging the country's mental health system. Judge Ken Mason was tasked with investigating the treatment of patients who had a mental health issues and a history of violent offending.

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It found the health a disability sector is complex and fragmented, and suggested slashing the number of DHBs.

1993: Four Regional Health Authorities (RHAs) were established - Northern, Midland, Central and Southern."

The purchasing and provision of health services were separated, heralding the establishment of the Government's drug-buying agency Pharmac - created in response to the rapid increases in the prices of medicine.

The Department of Health also become the Ministry of Health. The Area Health Boards were subsequently reconfigured into 23 Crown Health Enterprises.

1994: Robyn Stent became the country's first person appointed to the role of Health and Disability Commissioner.

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The Government's drug-buying agency Pharmac was set up in 1993 in response to rapidly increasing costs of buying medicines.

1996: The government-commissioned Mason Inquiry, chaired by former judge Ken Mason, was launched. It had a wider brief than the Mason Report of 1988, and looked at general mental health services and the failure to properly resource community care. The report recommended the Mental Health Commission be established.

1998: In order to streamline health administration, the four RHAs were combined into one national purchasing agency, the Health Funding Authority.

1999: The Government took the first step in its attempt to streamline health administration, with Health Minister Annette King signalling the intention to bring the Health Funding Authority into the Ministry of Health.

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Deputy Labour leader Annette King held the health portfolio as the Health Funding Authority was moved into the Ministry of Health in 1999.

2000: The Health Funding Authority, which was responsible for buying health services on behalf of the Government, and the Hospital and Health Services were disbanded.

2001: 21 DHBs were established, courtesy of the New Zealand Public Health and Disability Act 2000. DHBs are Crown entities which report to the Minister of Health and are funded through a population-based formula by the Ministry of Health.

DHBs were responsible for planning, funding and ensuring the provision of health and disability services across a geographical area.

2002: Primary Health Organisations (PHOs) were developed in 2002 to manage primary care, including general practitioners and their services.

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21 District Health Boards were established in 2001, but almost 20 years on, their numbers could be dramatically slashed.

2003: Population-based funding formula is introduced. It determined the share of funding allocated to each DHB based on the number of people living in each district. Its aim was to ensure the fair distribution of funding relative to the health and disability needs of their population.

2009: The Whnau Ora taskforce was set up.

Chaired by Professor Mason Durie, the taskforce was made up of six members. At the time, Mori Party co-leader Tariana Turia described Whnau Ora as the "way forward to achieving a future where whnau determine what is in their best interests".

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Tariana Turia and Prime Minister John Key arrive at the Beehive for a Whnau Ora press conference in 2010.

2010: Whnau Ora was launched, in recognition that the Government's standard ways of delivering social health services were not delivering good outcomes for Mori.

2012: Mental Health Commission, which came about after the release of the Mason Inquiry findings in 1996, was disestablished. Its core functions were transferred to a Mental Health Commissioner who was placed in the Office of the Health and Disability Commissioner.

BRADEN FASTIER / Stuff.co.nz

Former district court judge Ken Mason says there is once more a "groundswell of concern" from the public for an independent inquiry. First published in July 2017.

2020: Complete overhaul of New Zealand's health system proposed, including the slashing of DHB numbers from 20 to between eight and 12 in the next five years, and moving to fully appointed boards.

The final report of the Health and Disability System Review also recommended creating a new Crown Entity, tentatively called Health NZ, focusing on the operational delivery of health and disability services, and financial performance.

The creation of a new Mori Health Authority was also recommended, the new entity sitting alongside the Ministry of Health - which would take on a stewardship role and would focus on building its public health capacity - and Health NZ.

However, the review panel was split over the formulation of the proposed Mori Health Authority, with some claiming the authority's mandate was not ambitious enough and wouldn't sufficiently address Mori inequity in health outcomes.

Additional sources: Parliament website, Ministry of Health

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Timeline: The evolution of New Zealand's public health system - Stuff.co.nz