title: Testing times: New Zealand’s clinical laboratories under the 1990s health sector reforms

authors: France, Necia

abstract: This thesis examines New Zealand’s clinical laboratory services during the 1990s, a recent period of major neo-liberally driven health sector change in New Zealand. Internationally, although estimates of expenditure on laboratory services vary, the importance attributed to their pivotal role in health decision-making and expenditure is consistent. Consequently, changes impacting on the clinical laboratory system have the potential to resound throughout a national health service in unexpected ways. 

The 1990s New Zealand health reforms were characterised by a downplaying of the role of technical, scientific and clinical expertise in management decision making, a reduced role in management and planning for central government, and moves towards the creation of a ‘health market’ composed of consumers, rather than citizens. The transfer of occupational control from pathologists to managers in the clinical laboratory sector, and other attempts to contain state expenditure on clinical laboratories are monitored in the body of this thesis using both qualitative and quantitative data. 

Pre-reform weaknesses already present in the clinical laboratory service, particularly the dual systems for laboratory remuneration that hinge on specimen origin, were thrown into strong relief by the 1990s reforms. Furthermore, evidence gathered in this study suggests the reforms became counter-productive, even in their own terms. Thus, the change towards market controls not only destroyed strengths of the existing centrally controlled laboratory system, but also, by fostering a focus on outputs, greatly increased volume-driven state expenditure on laboratory testing. This occurred largely without improvement in disease ‘pick-up’ rates, avoidable hospitalisations, or cost-efficiencies. The internal market compromise proved powerless to avoid laboratory services monopoly development by foreign investor owned companies. As a consequence it neither indicated the most efficient test prices, nor engendered the physical laboratory amalgamations that have occurred overseas in the interests of cost-efficiency. 

The thesis concludes that the kind of structural reform introduced into the New Zealand health sector in the 1990s was a poor instrument for achieving cost effectiveness. Specific technological changes in laboratory practice, along with globalisation in health service provision, are identified as examples of design influences that will strongly re-shape the supply-side of New Zealand laboratory services. Their considered incorporation into a revived central, evidence-based, laboratory services redesign plan is strongly recommended. Unfortunately, the partially decentralised governance structure introduced by the Labour-led coalition in 2001 appears to have the potential to frustrate that recommendation.

text: Testing times: New Zealand’s clinical laboratories under the 1990s health sector reforms This thesis examines New Zealand’s clinical laboratory services during the 1990s, a recent period of major neo-liberally driven health sector change in New Zealand. Internationally, although estimates of expenditure on laboratory services vary, the importance attributed to their pivotal role in health decision-making and expenditure is consistent. Consequently, changes impacting on the clinical laboratory system have the potential to resound throughout a national health service in unexpected ways. 

The 1990s New Zealand health reforms were characterised by a downplaying of the role of technical, scientific and clinical expertise in management decision making, a reduced role in management and planning for central government, and moves towards the creation of a ‘health market’ composed of consumers, rather than citizens. The transfer of occupational control from pathologists to managers in the clinical laboratory sector, and other attempts to contain state expenditure on clinical laboratories are monitored in the body of this thesis using both qualitative and quantitative data. 

Pre-reform weaknesses already present in the clinical laboratory service, particularly the dual systems for laboratory remuneration that hinge on specimen origin, were thrown into strong relief by the 1990s reforms. Furthermore, evidence gathered in this study suggests the reforms became counter-productive, even in their own terms. Thus, the change towards market controls not only destroyed strengths of the existing centrally controlled laboratory system, but also, by fostering a focus on outputs, greatly increased volume-driven state expenditure on laboratory testing. This occurred largely without improvement in disease ‘pick-up’ rates, avoidable hospitalisations, or cost-efficiencies. The internal market compromise proved powerless to avoid laboratory services monopoly development by foreign investor owned companies. As a consequence it neither indicated the most efficient test prices, nor engendered the physical laboratory amalgamations that have occurred overseas in the interests of cost-efficiency. 

The thesis concludes that the kind of structural reform introduced into the New Zealand health sector in the 1990s was a poor instrument for achieving cost effectiveness. Specific technological changes in laboratory practice, along with globalisation in health service provision, are identified as examples of design influences that will strongly re-shape the supply-side of New Zealand laboratory services. Their considered incorporation into a revived central, evidence-based, laboratory services redesign plan is strongly recommended. Unfortunately, the partially decentralised governance structure introduced by the Labour-led coalition in 2001 appears to have the potential to frustrate that recommendation.

year: 2001

title: Evidence, interests and argumentation: an environmental policy controversy in a small New Zealand town

authors: Skilling, Peter

abstract: This article examines interactions between different forms of authoritative knowledge and evidence in a public dispute over an environmental problem. It draws on a case set in a small coastal town in New Zealand where the local community had expressed concern over the degradation of a river-mouth estuary caused by catchment management works built in the 1950s to support the farming sector. The estuary historically had been an important economic and cultural treasure for Indigenous Māori, and by the mid-20th century had become a valued recreational and fishing resource for the broader community. This article analyses a moment of dispute in the 1980s between those who called for the restoration of the estuary and those who wished to maintain the status quo. Drawing on an analysis of official reports, media coverage and other public documents, the article shows how the competing parties and their constructions of the collective good accorded authority and weight to specific histories, forms of evidence and kinds of people. The article understands the case not as a dispute between “the people” and “the experts” but rather as a moment where competing blocs drew on specific grammars of justification in their attempts to align their claims with the collective good.

text: Evidence, interests and argumentation: an environmental policy controversy in a small New Zealand town This article examines interactions between different forms of authoritative knowledge and evidence in a public dispute over an environmental problem. It draws on a case set in a small coastal town in New Zealand where the local community had expressed concern over the degradation of a river-mouth estuary caused by catchment management works built in the 1950s to support the farming sector. The estuary historically had been an important economic and cultural treasure for Indigenous Māori, and by the mid-20th century had become a valued recreational and fishing resource for the broader community. This article analyses a moment of dispute in the 1980s between those who called for the restoration of the estuary and those who wished to maintain the status quo. Drawing on an analysis of official reports, media coverage and other public documents, the article shows how the competing parties and their constructions of the collective good accorded authority and weight to specific histories, forms of evidence and kinds of people. The article understands the case not as a dispute between “the people” and “the experts” but rather as a moment where competing blocs drew on specific grammars of justification in their attempts to align their claims with the collective good.

year: 2021

title: Linking land, river and moana: Collaborative research between Te Whakatōhea and Lincoln University within the coastal rohe

authors: Morris, Richard

abstract: In the eastern Bay of Plenty, where the land yields to the Pacific and the Waioeka and Ōtara Rivers meet Te Moana aToi (the Bay of Plenty), a research partnership is flourishing between Te Whakatōhea iwi, Lincoln University Centre of Excellence Designing Future Productive Landscape (DFPL), and Waikato University. This collaboration has grown over several years into a suite of multidisciplinary research projects focused on agricultural systems design, urban planning, and climate resilience. While distinct in their objectives, these research threads are united by a deeper, unavoidable theme: the interconnection between whenua (land), awa (river), and moana (sea). For Te Whakatōhea, these are not separate domains but a continuous space of identity, sustenance, and economy, an ethos that sits well with DFPL.

text: Linking land, river and moana: Collaborative research between Te Whakatōhea and Lincoln University within the coastal rohe In the eastern Bay of Plenty, where the land yields to the Pacific and the Waioeka and Ōtara Rivers meet Te Moana aToi (the Bay of Plenty), a research partnership is flourishing between Te Whakatōhea iwi, Lincoln University Centre of Excellence Designing Future Productive Landscape (DFPL), and Waikato University. This collaboration has grown over several years into a suite of multidisciplinary research projects focused on agricultural systems design, urban planning, and climate resilience. While distinct in their objectives, these research threads are united by a deeper, unavoidable theme: the interconnection between whenua (land), awa (river), and moana (sea). For Te Whakatōhea, these are not separate domains but a continuous space of identity, sustenance, and economy, an ethos that sits well with DFPL.

year: 2025-11