New Zealand has 20 district health boards (DHBs) for a population of less than 5 million. Because of a lack of transparency, we do not know the costs of administering DHBs. But prima facie evidence suggests it is time to consolidate DHBs and free up administrative resources to use for additional services.
In health care, size matters. Returns to scale and quality gains come with size. Optimising governance arrangements and the scale of services means more choice and improved health outcomes as pressures from ageing and public expectations intensify.