ABSTRACT
This chapter reviews the development of primary care in New Zealand and consider this in an international context. In the 1930s the first Labour government in New Zealand sought to create a universal welfare system in which all doctors would be paid servants of the state. The Government was successful in targeting the weakest point of the general practice workforce, foreign medical graduates, by requiring them to work initially in rural or disadvantaged communities, and successfully challenged the dominance of medicine in maternity services by legislating to permit midwives to practice independently in the community. The period of 1991 to 1999 saw radical change in the organization of primary care, with the formation of doctor collectives, independent practitioner associations (IPAs), in response to market-style health reforms. The new model is based on structural reform, incorporating a strong managerialist ethos, placing doctors in a contractual relationship with PHOs with formal performance and reporting requirements.
