There will soon be a separate Māori Health Agency and fewer district health boards (DHBs), Health Minister Andrew Little has promised.
Little confirmed the changes, both recommended in the Health and Disability System Review earlier this year, will happen by the end of the Government's current term.
"Through my Treaty of Waitangi negotiations portfolio, I know the inequities that there are," Little told Newshub Nation on Saturday, talking about the proposed Māori Health Authority.
"Māori are suffering in a health system that is not treating them equally. If we're going to have a Māori health authority, I'm determined that it genuinely has the authority to really make a difference for Māori. I want to be sure that we're doing everything we can that it's a game-changer for Māori."
When the report, led by Helen Clark's former chief of staff Heather Simpson, was released in June, then-Health Minister David Clark said there was no longer any doubt Māori had unequal access to the health system.
"We can see historic evidence of that... I think there is. I think that it's very difficult to point to specific examples - that's the nature of institutional arrangements," Dr Clark told Newshub Nation at the time.
"But we are, as a Government, absolutely committed to making sure that we improve things into the future."
Dr Clark was replaced by Chris Hipkins after his well-publicised breaking of COVID-19 restrictions. Hipkins has kept responsibility for the COVID-19 response, but the overall health portfolio was given to Little after the election.
"I'm more than happy to take it on. It's a challenge, but look - I'm somebody who likes difficult problems and hard work, so I'm more than happy to do it."
His top priority is shaking up how the health system works, saying Cabinet liked the "direction of travel" of Simpson's report but the details remain to be worked over.
Part of it will be setting up a new health authority called Health NZ for closer operational oversight of DHBs, which will reduce in number from 20 to between eight and 12, as per Simpson's report.
"It's very clear we have a health system that is very good in a lot of respects, but lacks coordination and coherence... I think the issue about the DHBs is that in a system where it is totally Government-funded, does it make sense to have separately elected representatives whose purview is their little area, as opposed to the system as a whole?
"What the Simpsons report says is that there is a sense in which in the health system, too few people are thinking about the system as a whole. In a country of 5 million people in a health system that we've got, we've got to be thinking about the system - not little bits of it."
It's not yet determined which existing DHBs will be scrapped or merged. While the report said it should happen over a five-year timeframe, Little wants the bulk of the structural changes done by 2023, so they can get moving on the finer details.
Health NZ, Little says, will be better equipped at handling emergencies that require a cross-departmental response than the Ministry of Health.
"The ministry did a phenomenal job in terms of bringing the relevant parties together for the COVID-19 response, but it is kind of the exception that proves the rule. What it demonstrated was for some crucial parts - public health management is one of them - we are lacking coordination, and we need to improve that. So this is a way of pooling that together and ensuring there is some coherence to our public health leadership."
A number of vaccines for COVID-19 have shown promise in recent weeks. Little said it's Cabinet minister Megan Woods' job to procure safe and effective vaccines for New Zealand, and Hipkins' job to roll them out - and decide who gets them first.
But unlike some other countries which are seeking to roll out vaccines immediately, we're in a position to wait until they're definitively proven safe and effective.
"We want to make sure that what we put in place is right for New Zealand, suitable for New Zealand. We're very fortunate because of the way we've managed our response so far that we're not in the kind of parlous state many European countries and North American countries are in at the moment.
"That's not a way of saying 'let's not hurry' - we want to get something as quickly as possible - but we want to see through to the end of the phase III trials and we want to do what's right... We're in a position to do so. We don't want to go any slower than we need to, but we do want to make sure what we do is safe for New Zealanders."
