District Health Board (New Zealand)

District Health Boards (DHBs)in New Zealand are organisations established by the New Zealand Public Health and Disability Act 2000, responsible for ensuring the provision of health and disability services to populations within a defined geographical area. They have existed since 1 January 2001 when the Act came into force. There are 21 DHBs, 15 in the North Island and 6 in the South Island. DHBs receive public funding from the Ministry of Health on behalf of the Crown, based on a formula which takes into account the total number, age, socioeconomic status and ethnic mix of their population.

History
District Health Boards were first introduced as an idea in the 1970s in the Green and White Paper suggested by the then in-power Labour government. This was part of a plan to nationalise primary health care as the Social Security Act of 1938 had originally intended. Labour subsequently lost the election to Rob Muldoon's National Party in the 1975 election. Muldoon's government chose however to slowly implement these reforms in trial "Area Health Boards", which can be seen as early predecessors of the District Health Boards.

The more direct pre-decessors were the Crown Health Enterprises (CHEs) and subsequent Hospital and Health Services (HHS) management structures of the 1990s; these were responsible for managing the hospitals under business ethos, albeit, with the expectation that the former would return a profit to the shareholders (i.e. the government).

Following the neo-liberal "Big Bang" that occurred in the 1990s "Regional Health Authorities" (RHA) were formed. These RHAs were amalgamated in 1997 to form the Health Funding Authority. The election of the Labour-Alliance government in the 1999 General Election saw the New Zealand Public Health and Disability Act 2000 passed by parliament, this led to the merging of the HFA with the MoH. Part of the HFA's funding capacity combined with the hospital management elements of the Hospital and Health Services board to form the DHBs.

Organisation
The District Health Boards are given a set of objectives by the Ministry of Health, but have a degree of autonomy in how they choose to achieve these. In contrast to their predecessors, the Regional Health Authorities, the DHBs are non-profit providers. The performance of individual DHBs is monitored by the DHB Funding and Performance Directorate.

The DHBs are governed by boards, which consist of up to 11 members: seven elected by the public every three years, and up to four appointed by the Government's Minister of Health. These appointments are largely to balance the board's expertise as deemed necessary. Voting for public-elected DHB board members occurs through the Single Transferable Vote system.

Locations
There are 21 DHBs, organized around geographical areas, of varying population sizes, though they are not coterminous with the Regions of New Zealand: