Developing accountable care systems: Lessons from Canterbury, New Zealand

Study topic: Evaluation of Canterbury’s health system transformation and its relevance for accountable care systems, with a focus on integrated care and demand moderation.

Study type: Descriptive case study (policy analysis)

Key findings:

• Canterbury achieved a 13% reduction in the growth rate of acute medical admissions between 2003 and 2013, compared to national trends.
• Canterbury's response to the 2008 hospital rebuild challenge catalysed a system-wide shift toward integrated, accountable care, led by a unified strategic vision and strong clinical leadership.
• HealthPathways emerged as a key tool for standardising care, facilitating consistent clinical decision-making, and integrating primary and secondary care. It empowered GPs by making local referral and management information visible and actionable.
• Between 2008 and 2016, Canterbury achieved reductions in ED attendance growth (2% vs 12% national), fewer acute medical admissions for 65+, and lower care home admissions—demonstrating real impact of coordinated interventions.
• A whole-of-system focus on patient flow and reorienting care “closer to home” was enabled by innovations like the Acute Demand Management Service, Community Rehabilitation Enablement Support Team (CREST), and falls prevention programs.
• HealthPathways was central to improving the interface between primary and secondary care, enabling more diagnostics and procedures to be delivered in community settings and reducing waiting times.
• Relevance to HealthPathways: HealthPathways was not only a product of system transformation but a driver—helping articulate service gaps, unify clinical language, and act as a platform for co-design and continuous improvement.