In primary health care, however, the reforms did have
some positive outcomes. New networks developed to represent
GPs in negotiations with RHAs and hence to offset
the monopsony power of RHAs, but these also enabled new
ways of contracting to encourage increases in efficiency,
improvements in quality of care, and more services delivered
across general practices; as a result, RHAs did make
savings in primary health care expenditures. In addition,
with resources no longer automatically allocated to particular
providers and the ability of the RHAs to allocate
resources as they saw fit, it allowed many new Ma¯ori- and
Pacific-led providers to be established and funded, to better
deliver services to these higher-need populations [21, 22].
The reforms may, however, have also been detrimental
to health outcomes, with too much emphasis on costs and
insufficient emphasis on quality of care at times [23, 24].
In 1996, it was recommended that (1) the four RHAs be
amalgamated into a single, national purchasing authority to
reduce overall transaction costs and improve national
consistency and (2) that CHEs should become Hospital and
Health Services (HHSs), with their profit motive removed
but with continued expectations that they would be
expected to cover their costs [25]. Following a further
period of reorganisation [16], by late 1998, the single
Health Funding Authority (HFA) was established and was
beginning its work.