Changes to the public health system proposed in a government report will lead to a radical shake-up of the sector, according to senior doctors.
A ministerial review group that produced the report says the cost of public healthcare is growing faster than New Zealand's earnings, so bureaucracy must be cut back.
It calls for widespread changes in the bureaucracy and in working methods of the health force.
The report suggests keeping New Zealand's 21 district health boards, but creating a national agency to oversee them.
The Association of Salaried Medical Specialists says creating a powerful new entity would be expensive and increase bureaucracy.
However, a group representing about 4,000 GPs and nurses has welcomed the review into the cost and organisation of public health.
The Independent Practitioner Association Council says the proposals aim to push resources towards people who need care most.
Health Minister Tony Ryall says the changes will not be that radical, though he indicated that the changes could result in some redundancies as administrative functions, such as payroll and IT services, are consolidated.
He says a national agency could harness the power of bulk purchasing, with savings directed to frontline health services.
Mr Ryall says there is no recommendation in the report that workers should get treatment ahead of people who were not in the workforce, adding that equal access to care is the core of the public health service.
The review group says a second Crown agency is needed to provide district health boards with support services such as payroll administration. Mr Ryall says that will reduce unnecessary duplication, and free up funds for doctors and nurses.
But DHBs say proposed changes to the health system just continue the work they have already begun.
Mr Ryall says the Cabinet will consider the report over the next few months and the Government will seek public feedback on the 170 recommendations.
Prime Minister John Key says if the Government does end up taking action on the recommended health reforms, it would not breach National's pre-election promises.
Return to failed policies, says union
The largest public sector union says the report is a return to failed policies from the 1990s.
Critics say the proposal resembles the Health Funding Authority abolished in 2001.
National secretary of the Public Service Association Richard Wagstaff says the fashion for separating the policy and implementation arms from government ministries has not worked yet.
Mr Wagstaff says if the Government agrees to the proposed restructure, it will be expensive and disruptive, with no guarantee of success.
Nurses Organisation chief executive Geoff Annals says recommendations in the report will make some back-office Health Ministry staff feel disregarded and ill-used.
Mr Annals says it is very easy to denigrate people whose work is not as visible as doctors and nurses - but their work is no less important.
He says many of the report's findings make good sense, but nurses are not convinced that large structural change is needed to achieve them.
Opposition alarm
Opposition parties say they would be alarmed at any move to ration health services on the basis of how productive an individual might be.
The review group report suggests health decisions should not be made independent of economic considerations.
The Green Party says any suggestion that economic benefits take precedent when deciding treatment is disturbing.
