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: An investigation of microbial communities across two extreme geothermal gradients on Mt. Erebus, Victoria Land, Antarctica

authors: Smith, Emily

abstract: The geothermal fumaroles present on Mt. Erebus, Antarctica, are home to numerous unique and possibly endemic bacteria. The isolated nature of Mt. Erebus provides an opportunity to closely examine how geothermal physico-chemistry drives microbial community composition and structure. This study aimed at determining the effect of physico-chemical drivers on microbial community composition and structure along extreme thermal and geochemical gradients at two sites on Mt. Erebus: Tramway Ridge and Western Crater. Microbial community structure and physico-chemical soil characteristics were assessed via metabarcoding (16S rRNA) and geochemistry (temperature, pH, total carbon (TC), total nitrogen (TN) and ICP-MS elemental analysis along a thermal gradient 10 °C–64 °C), which also defined a geochemical gradient. Diversity increased in alkaline soils suggesting pH to be the primary driver of microbial community structure across the gradients. Archaea dominated the microbial communities at Tramway Ridge compared to Western Crater, which was dominated by Bacteria. Western Crater has been sampled for the first time, widening the understanding of geothermal sites on Mt. Erebus. Organisms that were once considered cosmopolitan may not be as cosmopolitan as expected in Antarctica. These organisms may require specific niches that allow them to colonise new habitats. This study also showed that gathering more samples from Tramway Ridge has widened understanding of the changing environments that microbial communities on Mt. Erebus live in. The study provides a foundation on which to compare microbial and geochemical interactions across all geothermal sites within Victoria Land. This supports the effect of specific geothermal characteristics of the fumaroles in manipulating the microbial communities present.

text: An investigation of microbial communities across two extreme geothermal gradients on Mt. Erebus, Victoria Land, Antarctica The geothermal fumaroles present on Mt. Erebus, Antarctica, are home to numerous unique and possibly endemic bacteria. The isolated nature of Mt. Erebus provides an opportunity to closely examine how geothermal physico-chemistry drives microbial community composition and structure. This study aimed at determining the effect of physico-chemical drivers on microbial community composition and structure along extreme thermal and geochemical gradients at two sites on Mt. Erebus: Tramway Ridge and Western Crater. Microbial community structure and physico-chemical soil characteristics were assessed via metabarcoding (16S rRNA) and geochemistry (temperature, pH, total carbon (TC), total nitrogen (TN) and ICP-MS elemental analysis along a thermal gradient 10 °C–64 °C), which also defined a geochemical gradient. Diversity increased in alkaline soils suggesting pH to be the primary driver of microbial community structure across the gradients. Archaea dominated the microbial communities at Tramway Ridge compared to Western Crater, which was dominated by Bacteria. Western Crater has been sampled for the first time, widening the understanding of geothermal sites on Mt. Erebus. Organisms that were once considered cosmopolitan may not be as cosmopolitan as expected in Antarctica. These organisms may require specific niches that allow them to colonise new habitats. This study also showed that gathering more samples from Tramway Ridge has widened understanding of the changing environments that microbial communities on Mt. Erebus live in. The study provides a foundation on which to compare microbial and geochemical interactions across all geothermal sites within Victoria Land. This supports the effect of specific geothermal characteristics of the fumaroles in manipulating the microbial communities present.

year: 2021

title: Frozen rights?: The right to develop Maori treaty and aboriginal rights

authors: Joseph, Robert

subjects: Maori

abstract: Bishop Manuhuia Bennett often asked the question: "What did Maori call New Zealand before the arrival of the Pakeha [Europeans]?" After a deliberate pause, he would then simply utter: "Ours".

text: Frozen rights?: The right to develop Maori treaty and aboriginal rights Bishop Manuhuia Bennett often asked the question: "What did Maori call New Zealand before the arrival of the Pakeha [Europeans]?" After a deliberate pause, he would then simply utter: "Ours".

year: 2011