New Zealand's health and disability system is described by a review as "complicated and very fragmented", with "leadership lacking at all levels".
The Health and Disability System Review Panel released its interim report on Tuesday, highlighting several key areas preventing access to the sector's services.
Māori have "not been served well by the system", the review found, while rural communities are facing "particular challenges and need solutions designed specifically for them".
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It also found that the "way people work in the system is not leading to the most productive results", while there's concern healthcare organisations "do not cooperate well".
"Many professionals resist collaborating across disciplines, there is a lack of flexibility in employment arrangements, and a general resistance to change at many levels."
And money wasn't the main barrier preventing consumers from accessing the sector. The review found that time, the cost of transport and "lack of culturally appropriate services" is also "significant barriers".
"New Zealand research shows that self-reported experience of racism, including by health professionals, is higher for Māori, Pacific peoples, and Asian peoples than for European/Other people."
It said despite many good examples of kaupapa Māori services proving their effectiveness, the "system overall has not delivered Māori health and wellbeing outcomes that are fair".
Panel chair Heather Simpson said on Tuesday health systems around the world are under intense pressure and New Zealand is no different. She said the pressures include:
- increasing demand
- an ageing population
- the health effects of climate change
- the potential created by advances in clinical practice and digital technologies
- inequities of outcomes among Māori, low income and rural communities
"We have identified the likely reform themes and directions but significantly more discussion and evaluation is needed before we will be in a position to bring our thinking to recommendation stage."
Simpson highlighted how almost 8.5 percent of the entire New Zealand workforce is employed in some form in the health sector.
But despite commitment and "good intentions" of most of those working in it, the current system is "not performing equally with respect to all New Zealanders".
She noted how the Treaty of Waitangi guaranteed Māori their full rights and benefits as citizens, yet more than 80 years after the establishment of the public health system, the outcomes for Māori are "still significantly poorer".
Panel members visited district health boards (DHBs), met with stakeholders, held workshops around the country, and held an online submission process to come to their conclusions.
The panel is calling for a more "collaborative and cooperative approach" for the health sector, which will "require changes in attitude and culture".
"There needs to be a long term, nationwide health and disability service plan and more effective strategic planning throughout the system."
The panel also wants a "national asset management plan" and a "long-term investment strategy" for the health sector because capital and infrastructure management in the system has "not been impressive".
Health makes up about a fifth of government spending. Over the next two years, an additional $1.7 billion will be invested in health sector capital projects.
The next phase of the health sector review will focus on making concrete recommendations for the Ministry of Health to consider.
Despite a "high degree of consensus on the issues preventing the system being as effective as it could be", the report says there was "much less consensus on the best way forward".
"The reality is that the world is rapidly changing. Changing demographics alone will increase demands on the system making it unsustainable unless it operates very differently in the future."
The interim report was delivered to Health Minister David Clark last week.