The number of district health boards should be slashed by up to three quarters, a visiting health policy expert says.
Colorado Health Institute vice-president Amy Downs spent seven months in this country between February and August under an Ian Axford Fellowship, and was hosted by Treasury.
In a report of her findings, she said New Zealand had fallen short of some of its objectives to improve access to community care.
District health boards had been criticised for operating in regional and financial isolation "without focusing on systemic and long-term health outcomes among New Zealanders", she said.
"Almost everyone I spoke with (including chief executives of DHBs) agreed that these issues are exacerbated because there are too many DHBs."
Downs said her sources attributed the "surplus" of boards to the contentious health reforms of the 1990s, when organisations - including hospitals - competed against each other for business.
"Key informants generally thought that a country the size of New Zealand could support around four to six DHBs and [primary health organisations] with similar geographic configurations."
Primary health organisations were set up as not-for-profit groups responsible for managing and improving the health of an enrolled population.
However, there were too many of them, Downs found.
"While there has been significant consolidation from over 80 to 31, this number is likely still too high. Currently, some DHBs are working with up to five different PHOs and some PHOs are working with up to four DHBs."
She criticised the Very Low Cost Access scheme, under which some clinics are funded to provide low fees, regardless of their patients' income.
More rigorous funding that followed the patient, rather than the practice, would better compensate providers for caring for complex patients.
Her sources were concerned the government had underfunded primary care. "To compensate for insufficient resources, primary care providers are increasing patient fees."
However, although there had been media attention given to recent fee increases at low-cost practices, the substantive fee increases happened five to nine years ago, her data showed.
Downs highlighted a lack of data, analysis and monitoring in primary care as another problem and said the Health Ministry and Treasury should collaborate on improving that.
"While the government provides over $900 million to subsidise primary health services, it has little information regarding quality, utilisation and outcomes of different types of primary care services."