When the former Labour-led government unveiled the Pae Ora (Healthy Futures) reforms in 2022, it billed them as the biggest shakeup of New Zealand’s health system in a generation.

The sweeping overhaul promised to end chronic fragmentation and narrow postcode-based gaps in care, and to tackle long-standing health inequities.

Three years on – and with a change in government – what can we say that it delivered?

We explored this question in a soon-to-be-published analysis and found that the picture is mixed. While national co-ordination has improved crisis response and planning, everyday access to primary care – especially GP appointments – has become harder for many people.

The shift in political direction has also revealed a deeper lesson: structural reform can build capacity, but without durable political consensus and clear accountability, any gains in equity remain fragile.

The reforms replaced 20 district health boards with a single national organisation, Health New Zealand, and created a Māori Health Authority to embed Treaty-based governance and commissioning.

It was a major milestone in New Zealand, recognising Māori leadership in the health system and te Tiriti partnership. The aim was straightforward. A more centralised system could plan better, respond faster in crises and deliver more consistent........

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