{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:07:27Z","timestamp":1792087647417,"version":"4.4.0"},"reference-count":0,"publisher":"Pasifika Medical Association Group","issue":"1632","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NZMJ"],"abstract":"<jats:p>New Zealand\u2019s health system is under sustained pressure, with worsening access to primary and specialist care, widening inequities\nand declining public confidence. In this context, there is an emerging but largely unarticulated shift towards increased reliance on\nprivate provision and private financing. This editorial examines whether this represents privatisation by design, default or drift, and\nconsiders the likely consequences. Evidence from New Zealand and comparable health systems suggests that increased privatisation is\nassociated with higher costs, reduced equity and no consistent improvement in outcomes. Rising private insurance costs, outsourcing\nof elective services and public\u2013private partnerships risk undermining the sustainability of the public system while failing to address the\nfundamental drivers of demand, particularly chronic disease and unmet need in primary care. These trends disproportionately affect\nM\u0101ori, Pacific peoples and low-income populations, raising concerns regarding Te Tiriti o Waitangi obligations. An alternative approach\nis proposed, centred on sustained investment in primary care and prevention, a clearly defined core package of publicly funded\nservices and a cross-party health accord to ensure policy stability. The future of New Zealand\u2019s health system will depend on deliberate\nchoices about equity, access and the role of the public sector.<\/jats:p>","DOI":"10.26635\/6965.7452","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T01:14:10Z","timestamp":1774228450000},"page":"9-12","source":"Crossref","is-referenced-by-count":1,"title":["Privatisation by stealth, design or default? The future of New Zealand\u2019s health system"],"prefix":"10.26635","volume":"139","author":[{"given":"Erik","family":"Monasterio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamubeel","family":"Eaqub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11177","published-online":{"date-parts":[[2026,3,27]]},"container-title":["New Zealand Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T01:14:11Z","timestamp":1774228451000},"score":1,"resource":{"primary":{"URL":"https:\/\/nzmj.org.nz\/journal\/vol-139-no-1632\/privatisation-by-stealth-design-or-default-the-future-of-new-zealand-s-health-system"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":0,"journal-issue":{"issue":"1632","published-online":{"date-parts":[[2026,3,27]]}},"URL":"https:\/\/doi.org\/10.26635\/6965.7452","relation":{},"ISSN":["1175-8716"],"issn-type":[{"value":"1175-8716","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}