Levy, Lester2025-08-242025-08-242025-08-15N Z Med J, ISSN: 0301-6331 (Print); 1175-8716 (Online), Pasifika Medical Association Group, 138(1620), 9-12. doi: 10.26635/6965.e16200301-63311175-8716http://hdl.handle.net/10292/19716By the early 2020s, New Zealand’s public health system faced deep-seated and widely acknowledged problems. Long before the COVID-19 pandemic, performance on key indicators—from emergency department waits to access to elective surgery—had been declining. These trends reflected structural fragmentation, variable local governance, outdated infrastructure and the absence of a coherent national delivery model.Open Access. The NZMJ offers free open access for all individuals that subscribe to the journal. The New Zealand Medical Journal is fully available to individual subscribers and does not incur a subscription fee.32 Biomedical and Clinical Sciences42 Health Sciences11 Medical and Health SciencesGeneral & Internal Medicine32 Biomedical and clinical sciences42 Health sciencesJournal ArticleOpenAccess10.26635/6965.e1620