School of Population Health

Health Systems - Research

Until 2010, our research was administered under the Centre for Health Services Research and Policy (CHSRP). However in 2012, the Health Systems section became an associate of the National Institute for Health Innovation (NIHI). The vision of NIHI is to apply innovative approaches to new models of healthcare and to improving individual and population health.

Research in Health Systems covers a range of disciplines and expertise including health economics, health management, programme evaluation, health services research, organizational psychology and public health ethics. Our broad aims are to advance understanding of the structure, processes and effects of health services and health policy, with a view to the more effective management and delivery of services and a more efficient and equitable health system. Research areas are wide ranging and include, but are not limited to:

  • Evaluation of health services and programmes
  • Economic evaluation of health interventions
  • Health policy analysis
  • Development of the conceptual and theoretical components which underlie health services and health policy research
  • Conduct and analysis of national surveys
  • Analysis of health data
  • Analysis of organisational behaviour
  • Health Leadership
  • Organisational Development related to Health Care Organisations
  • Health Workforce Retention
  • Health Coaching

Current projects

Evaluation of Urgent Care Initiatives in the Auckland region. We are evaluating recent initiatives in urgent care in the greater Auckland region that seek to:

  • (i) reduce the impact of cost barriers on primary care utilisation after-hours, and
  • (ii) shift some urgent care demand from hospital emergency departments (EDs) to (A & M) clinics.

These initiatives are the after-hours initiative (AH) in which after-hours services provided by A & Ms for targeted population groups are subsidised, and telephone triage (TT) services are expanded; and the St John Transport Project (SJTP), which enables ambulances to transfer low acuity patients to A & M centres instead of EDs, by subsidising the patients’ A & M co-payment. The research adopts a mixed-methods approach, in which we conduct key informant interviews, a survey of after hours patients in EDs and A & Ms, focus groups with patients and providers, interviews with general practitioners, and the collection and analysis of service utilisation data. This research is funded by the HRC and the Ministry of Health under their Partnership Programme for researching the Better, Sooner, More Convenient Primary Health Care initiative.

Implementing models of primary health care for older adults with complex needs: In this HRC-funded project, we are collaborating with a team of Canadian researchers to examine what are the steps to the successful implementation and scaling-up of integrated models of community-based primary health care that address health and social needs and improve outcomes for older adults with complex care needs. Key outcomes of this research will be performance measures at the patient/family, provider, organisation and system levels, and a systematic guide to the design, implementation and scaling-up of innovative models of community-based primary health care.

The QUALICOPC project: This project aims to evaluate primary care systems in 31 countries against criteria of quality, equity and costs. Data collection in New Zealand has been funded by the Ministry of Health. See the Qualicopc website.

Shorter Stays in Emergency Departments (SSED): The SSED National Research Project is a joint HRC-funded project between Auckland District Health Board and the University of Auckland investigating the effect of the 6hr NZ ED time target on clinical markers of quality of care and the process of policy implementation. See the SSED Research website.

The costs and complications of prostate cancer: This HRC-funded study, led by Prof Ross Lawrenson, is investigating the spectrum of complications arising from the diagnosis and treatment of prostate cancer. Researchers from Health Systems are estimating the costs of associated care to individuals and the health service.

Recent publications and reports



WILKINSON-MEYERS, L.E; BROWN, P.M; MCNEILL, R; REEVE, J; PATSTON, P; BAKER, R. 'To live an ordinary life: resource needs and additional costs for people with a physical impairment', Disability & Society, 2015, 10.1080/09687599.2015.1061479.

GARDINER, C; BRERETON, L; FREY, R; WILKINSON-MEYERS, L; GOTT, M. 'Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review.', Health & social care in the community, 2015, 10.1111/hsc.12253. ASHTON T., Hospitalizations of nursing homes residents: the role of reimbursement policies. Israel Journal of Health Policy Research, 2014, 3:3  doi:10.1186/2045-4015-3-3 [online]


DWYER J., BOULTON A., LAUOIE J. G., TENBENSEL T., CUMMING J. Indigenous Peoples’ Health Car: New approaches to contracting and accountability at the public administration frontier. Public Management Review, 23 Dec 2013. [online]

LEE R., NORTH N., Barriers to Maori sole mothers’ primary health care access. J PRIM HEALTH CARE, 2013, 5(4):315–321.

NORTH N., LEUNG W. & LEE R. Aged over 50 years and practising: separation and changes in nursing practice among New Zealand’s older Registered Nurses. Journal of Advanced Nursing 2014, 00(0), 000–000. doi: 10.1111/jan.12426

WILKINSON-MEYERS L., BROWN P., MCLEAN C. and KERSE N. Met and unmet need for personal assistance among community-dwelling New Zealanders 75 years and over. Health & Social Care in the Community, 2013. doi: 10.1111/hsc.12087. [online]

GARDINER, C; BRERETON, L; FREY, R; WILKINSON-MEYERS, L; GOTT, M. 'Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review.', Health & social care in the community, 2015, 10.1111/hsc.12253.

KERSE, N; MCLEAN, C; MOYES, S.A; PERI, K; NG, T; WILKINSON-MEYERS, L; BROWN, P; LATHAM, N; CONNOLLY, M. 'The cluster-randomized BRIGHT trial: Proactive case finding for community-dwelling older adults.', Annals of family medicine, 12, (6), p514-524, 2014, 10.1370/afm.1696. 

WILKINSON-MEYERS, L; BROWN, P; REEVE, J; MCNEILL, R; PATSTON, P; DYLAN, S; BAKER, R; RYAN, B; MCELDOWNEY, J. 'Reducing disablement with adequate and appropriate resources: a New Zealand perspective', Disability & Society, 29, (10), p1540-1553, 2014, 10.1080/09687599.2014.966803. 

GARDINER, C; BERETON, L; FREY, R.A; WILKISON-MEYERS, L; GOTT, M. 'Exploring the financial impact of caring for family members receiving palliative and end-of-life care: A systematic review of the literature', Palliative Medicine, 28, (5), p375-390, 2014, 10.1177/0269216313510588. 

WILLIAMS C., ASHTON T., BULLEN C. Using human rights to design aid-funded health programs so the first do no harm. Human Rights Quarterly 36(2): 428-446, 2014


ASHTON T. The New Zealand health system after 75 years: let's stop and smell the roses. New Zealand Medical Journal 126(1380). 16 August 2013. [online]

ASHTON T., BROWN P., SOPINA E., CAMERON L., TENBENSEL T., and WINDSOR J. Sources of Satisfaction and Dissatisfaction among Specialists within the Public and Private Health Sectors. [In English]. The New Zealand Medical Journal. 126, no. 1383 (2013 Sep 27 2013). [online]

BROAD J., ASHTON T., LUMLEY T., CONNOLLY MJ. Reports of the proportion of older people living in long-term care: a cautionary tale from New Zealand. Australian and New Zealand Journal of Public Health 37(3): 264-271, 2013. [online]

DWYER J, BOULTON A, LAUOIE J G, TENBENSEL T, CUMMING J Indigenous Peoples’ Health Car: New approaches to contracting and accountability at the public administration frontier. Public Management Review, 23 Dec 2013. [online]

LIANG, J., DAY, K., & MCFARLANE, R. 'Listen Please' - a clinical translation applicaiton. Paper presented at the HINZ 2013 Conference and Exhibition, Rotorua, New Zealand (2013, 27 - 29 November).

LUCAS, J., DAY, K., & HONEY, M. Considering telemedicine in acute care. Paper presented at the meeting of Successes and Failures in Telehealth. 4th Annual Meeting of the Australasian Telehealth Society, Brisbane, Australia.(2013)

MCCABE, C., EDLIN, R., MEADS, D., BROWNE, C., KHARROUBI, S. Constructing indirect utility models: some observations on the principles and practice of mapping to obtain health state utilities. Pharmacoeconomics, 2013, 31(8):635-41. [online]

RAGABAN, N., DAY, K., & ORR, M. Central leadership, governance, and regional cooperation in implementing the National Health IT plan. Paper presented at the HINZ 2013 Conference and Exhibition, Rotorua, New Zealand (2013a, 27 - 29 November).

RAGABAN, N., DAY, K., & ORR, M. Figures of vision: From triangle to pohutakawa tree. Paper presented at the HINZ 2013 Conference and Exhibition, Rotorua, New Zealand (2013b, 27 - 29 November).

SOTO LORCA, M., DAY, K., & ORR, M. Exploring the role of information technology systems in preventing and managing pre-analytic laboratory errors. Paper presented at the HINZ 2013 Conference and Exhibition, Rotorua, New Zealand (2013, 27 - 29 November).

TENBENSEL T, EDLIN R, FIELD A, WALTON L, NEUWELT P, REES D Auckland Regional After Hours Network Phase 1 Evaluation Final Report Auckland Regional AfterHours Healthcare Network [online]

TENBENSEL T, DWYER J, LAVOIE J How not to kill the golden goose: Reconceptualising accountability environments of community-based third sector organisations Public Management Review 2013 forthcoming [online]

TENBENSEL, T. Complexity in Health and Health Care Systems. Social Science & Medicine. [online]

WOOD A., TENBENSEL T., and UTTER J. The Divergence of Country of Origin Labelling Regulations between Australia and New Zealand. Food Policy. Vol 43 (2013): 132-41. [online]


APPLETON-DYER, S., CLINTON, J., CARSWELL, P., MCNEILL, R. Understanding Evaluation Influence Within Public Sector Partnerships: A Conceptual Model. American Journal of Evaluation 2012; published online May 18 2012, doi: 10.1177/1098214012447672 [online]

ASHTON T., BRAMLEY D., ARMSTRONG D. Improving the productivity of elective surgery through a new 'Package of Care'. Health Policy. Doi: 10.1016/j.healthpol.2012.08.007 [online]

ASHTON, T. and SOPINA, E. Value for money from HPV vaccination an cervical screening. Human Vaccines & Immunotherapeutics 8 (7): 1–3; July 2012. DOI:10.4161/hv.19807 [online]

ASHTON T., TENBENSEL T. Health reform in New Zealand: short-term gain but long-term pain? Expert Review of Pharmacoeconomics & Outcomes Research. 10/2012; 12(5):579-88. DOI:10.1586/erp.12.58 [online]

COSTA M.L., ACHTEN, J., PARSONS, N.R., EDLIN, R.P., FOGUET, P., PRAKASH, U., GRIFFIN, D.R. Total Hip Arthroplasty Versus Resurfacing Arthroplasty in the Treatment of Patients with Arthritis of the Hip Joint: Single Centre, Parallel Group, Assessor Blinded, Randomised Controlled Trial British Medical Journal 2012; published 19 April 2012; 344 doi: 10.1136/bmj.e2147 [online]

CULLEN, J., BRAMLEY, D., ARMSTRONG, D., BUTLER, L., ROUSE, P., ASHTON, T. Increasing productivity, reducing cost and improving quality in Elective Surgery in New Zealand – the Waitemata DHB joint arthroplasty pilot. Internal Medicine, 2012. DOI:: 10.1111/j.1445-5994.2012.02815.x , 2012. [online]

GLIDEWELL, L., THOMAS, R., MACLENNAN, G., BONETTI, D., JOHNSTON, M, ECCLES, M.P., GRIMSHAW, J., EDLIN, R., PITTS, N.B., CLARKSON, J., STEEN S., WALKER, A. Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? Two randomised controlled trials. BMC Health Services Research 2012, 12:250 (14 August 2012) doi: 10.1186/1472-6963-12-250 [online]

HALL, P., EDLIN, R., KHARROUBI, S., GREGORY, W., MCCABE, C. Expected Net Present Value of Sample Information: from burden to investment. Medical Decision Making, April 2012. DOI: 10.1177/0272989X12443010 [online]

JAYARAM L, WONG CA, KARALUS N, ASHTON T. Azithromycin Decreases Exacerbations In Non-Cystic Fibrosis Bronchiectasis Respirology 17:35-35 01 April 2012 [online]

JOHN D., ASHTON T., NIRMALAN P., PARIKH R. Cost effectiveness analysis of community screening for glaucoma in India. Value in Health 15(7):A643-A643 01 Nov 2012.

JONES, P., CHALMERS, L., WELLS, S., AMERATUNGA, S., CARSWELL, P., ASHTON T., CURTIS E., REID P., STEWART J., HARPER A., TENBENSEL. T. Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol. BMC Health Services Research, 12 (45):, 2012. DOI:10.1186/1472-6963-12-45, 2012. [online]

KOLT, G., SCHOFIELD, G., KERSE, N., GARRET, N., ASHTON, T. AND PATEL, A. Healthy Steps trial: Effectiveness of a pedometer-based Green Prescription for low-active older adults - randomized controlled trial. Annals of Family Medicine, 2012;206-212. DOI:10.1370/afm.1345. [online]

LAL, A., MOODIE, M., ASHTON, T., SIAHPUSH, M., SWINBURN, B. Health care and lost productivity costs of overweight and obesity in New Zealand. Australian and New Zealand Journal of Public Health. 2012; 36:550-6. doi: 10.1111/j.1753-6405.2012.00931.x

LEUNG, W., ASHTON, T., KOLT G., SCHOFIELD, G., GARRETT, N., KERSE, N. and PATEL, A. Cost-effectiveness of pedometer-based versus time-based Green Prescriptions: The Healthy Steps Study. Australian Journal of Primary Health. 2012. [online]

NORTH N, HUGHES F. A systems perspective on nursing productivity. Journal of Health Organization and Management 2012, Vol. 26 Iss: 2 pp. 192 - 214 [online]

NORTH, N.H., LEUNG, W., ASHTON, T., RASMUSSEN, E., HUGHES, F., FINLAYSON, M.P., Nurse turnover in New Zealand: costs and relationships with staffing practices and patient outcomes. Journal of Nursing Management, 4 May 2012. Doi: 10.1111/j.1365-2834.2012.01371 [online]

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Overview. Auckland: UniServices: University of Auckland

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Part One: Overview of the Study. Auckland: UniServices: University of Auckland

NORTH, N., MAHONY, F, (Feb 2012) Increasing the effectiveness of the HEHA (Healthy Eating Healthy Action Oranga Kai Pumau) Workforce – Part Two: Individual reports on Improvement Interventions. Auckland: UniServices: University of Auckland

O’SULLIVAN, J. ASHTON. T. A minimum income for healthy living: older New Zealanders. Ageing and Society. 32: 747-768, 2012. DOI:10.1017/So144686X11000559 [online]

ST JOHN S., DALE C., ASHTON T. A new approach to funding the costs of New Zealand’s ageing population. New Zealand Population Review. 38: 55-76, 2012. [online]

TENBENSEL, T., EAGLE, S. and ASHTON, T. Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity. Health Policy, 2012. DOI: 10.1016/j.healthpol.2012.04.011 [online]

ZENG W, NORTH N, KENT B. A framework to understand depression among older persons. Journal of Clinical Nursing 21(17-18):2399-2409 Sep 2012 [online]

ZENG W, NORTH N, KENT B. Methodological Challenges to Research Among Chinese: Using Mixed Methods to Investigate Older Persons with Depression in Macau. Journal of Mixed Methods Research 2012 Vol 6: 154-165 July 2012 [online]


ASHTON. T. AND BAUTISTA, M. ‘Purchasing Health Services in New Zealand’ In: Jalilian, H., & Sen, V. (Eds.), Improving Health Sector Performance: Institutions, Motivations and Incentives, 2011. p136-148, Singapore, Institute of Southeast Asian Studies.

ASHTON, T., SOPINA, E., WALTON, L. AND LEUNG W. Productivity Of Models Of Elective Surgery. Report prepared for the Waitemata Disctrict Health Board. July 2011.

CLINTON, J. M., PERCIVAL, T., O'CONNOR, T., & MAHONY, F. M. Evaluation of the Enua Ola: Pacific HEHA project A Summative Report of the past three years. Auckland: UniServices: University of Auckland. July 2011.

CLINTON, J. M., ANDREWS, S., MAHONY, F. M., & CHIANG, W. The Selwyn Foundation Parish Partnership Scheme: Selwyn Centres Independent Evaluation Final report. Auckland: UniServices: University of Auckland. May 2011.

EDLIN, R., TSUCHIYA, A., DOLAN, P. Public preferences for responsibility versus public preferences for reducing inequalities. Health Economics, 2011. DOI: 10.1002/hec.1799.

DRETZKE, J., EDLIN, R., ROUND. J., CONNOCK, M., HULME, C., CZECZOT, J., FRY SMITH, A., MCCABE, C., MEADS, C. A systematic review and economic evaluation of the use of tumour necrosis factor alpha (TNF α) inhibitors adalimumab and infliximab for Crohn’s disease. Health Technology Assessment 15(6), 2011. DOI: 10.3310/hta15060

NORTH, N., KERSE, N., MAHONY, F. M., & CHIANG, W. (2011, December). Independent Evaluation of the Enhanced Home Based Support Services for Older People. Auckland: UniServices: University of Auckland.

OKMA, K. CRIVELLI, L., ASHTON, T., TENBENSEL, T. CHENG, T-M.,et al. ‘Under the Radar Screen: Health Care Reforms in Seven Small Countries’. Ch 8 in G. Cohen, BW Ansell, J Gingrich and RH Cox (eds) Social Policy in the Smaller European Union States. New York: Berghahn Books. 2011, pp179 – 214.

PANATTONI, L., VAITHIANATHAN, R., ASHTON, T., LEWIS, G. Predictive risk modelling in health: options for New Zealand and Australia. Australian Health Review. 35:45-51, 2011

ROY, D. E., MAHONY, F. M., HORSBURGH, M., & BYCROFT, J. Partnering in primary care in New Zealand: clients' and nurses' experience of the Flinders Program in the management of long term conditions. Journal of Nursing and Healthcare of Chronic Illness, 3, 140-149, 2011. DOI:10.1111/j.1752-9824.2011.01088.x

SHERIDAN, N. F., KENEALY, T. W., CONNOLLY, M. J., MAHONY, F., BARBER, P. A., BOYD, M. A., MOFFITT, A. Health equity in the New Zealand health care system: a national survey. International Journal of Equity in Health, 10, 45, 2011. Doi:10.1186/1475-9276-10-45

SILVA, M., ASHTON, T., MCNEILL, R. Improving termination of pregnancy services in New Zealand. New Zealand Medical Journal. 124(1339). 29 July 2011.

SILVA, M., MCNEILL, R., ASHTON, T. Factors affecting delays in first trimester pregnancy termination services in New Zealand. Australian and New Zealand Journal of Public Health. 35(2): 140-145, 2011.

SOPINA, E., ASHTON,T. Cost-effectiveness of a cervical screening programme with HPV Vaccine. International Journal of Technology Assessment in Health Care. 27 (4): 290-297, 2011.

TENBENSEL, T., MAYS, N. & CUMMING, J. M. A successful mix of hierarchy and collaboration?: Interpreting the 2001 reform of the governance of the New Zealand public health system. Policy & Politics, 39: 2 pp239-256, 2011..