New Zealand is remarkably like the Republic, both demographically and in the structure of its health system. It provides invaluable lessons for those about to reform the Irish healthcare system.
New Zealand has a population of 3.83 million, with a marked divide between the number who live on the North Island - three million people - and on the sparsely populated, more rural South Island.
There is a mix of public and private healthcare, just as there is in the Republic. A network of private hospitals co-exists with a government-funded public-hospital system.
Of 444 hospitals in New Zealand, 360 are private, although the number of beds, at approximately 12,000 in each sector, is more evenly divided.
GP services are part of the private system, with almost everyone having to pay at least part of the professional fee. The cost of drugs is partially subsidised. Dental and optical services must be paid for in full. Physiotherapists and chiropractors are private practitioners also.
According to Claire Austin, the chief executive of the Royal New Zealand College of General Practitioners, primary care needs more resources if the system's large unmet need is to be addressed.
"There have been some concerns around the quality of medical care and accountability. We also need to focus on funding a proper system of population-based healthcare," she says.
Austin says the average New Zealander is still very concerned about health, following a series of failed reforms 10 years ago.
New Zealand is a good example of some of the pitfalls of reforming a health service. During the late 1980s and 1990s, the country experienced the most dramatic decline in the public share of health expenditure of any OECD country.
In 1993, a conservative government introduced an internal market for health. Even more extreme than Margaret Thatcher's reforms in the UK, it quickly became an issue of deep public concern.
By 1996, central government was forced to reorganise a health system that is once again seen as a public good to be delivered by the state. The latest version is attracting much international attention.
New Zealand now has 21 elected District Health Boards, which are responsible for providing core services.
A broad health strategy was published in December last year, followed by a specific primary-care strategy earlier this year.
Healthcare remains a live issue among New Zealanders, and the forced changes of the 1990s continue to drive public debate and political responses.
What are the current issues? Reducing inequalities in the public health service is a priority. In particular, the Maori population needs to see a targeted improvement in a broad range of services, in an attempt to reduce high levels of chronic disease.
Primary-care structures are seen as weak. While some GPs are organised into large groups, known as independent practice associations, most work alone, with no track record of teamwork. One of the main aims of the recent primary-care strategy is to develop a team approach within the sector.
Some of the obstacles to be overcome include difficulties in the recruitment - and retention - of rural practitioners and a potential shortage of other the health professionals needed to provide an expanded primary-care service.
The New Zealand government is also keen to introduce an advanced-nurse-practitioner grade, with a view to developing the health service in rural areas and for the Maori population.
Only 40 per cent of GP services are publicly funded at present. This compares with medical-card coverage of 30 per cent of the population of the Republic.
To use subsidised GP services, a New Zealander must have either a Community Services Card, which is broadly the equivalent of a medical card, with eligibility based on income, or a High Use Health Card, which is for people with chronic illness who visit a doctor more than 12 times a year.
Both schemes mean the patient pays a reduced GP fee as well as a reduced amount for each prescription from the community pharmacist. Only medication on a government-approved schedule will be subsidised; if you want another drug, you must pay in full, even if you have one of the cards.
At a secondary level, the District Health Boards purchase services from some providers but actually own and operate the public hospitals.
The core principle of funding healthcare based purely on population is a good one; it is meeting some problems, however, as it continues a transition from the market-forces principle of the early 1990s.
There is an inherent danger of overdeveloping the bureaucracy of the District Health Boards. In addition, an equitable population-based system requires that everyone register for healthcare and be given an identification number.
Those wary of Big Brother have managed to make registration voluntary, however, which could cause equity problems in years to come if not everybody chooses to register. There is a fear that those most at risk are those least likely to enrol in primary-care programmes.
But there is evidence that proposed reforms can work. The Tauranga Network was set up as a pilot programme alongside the principal reforms of 1993.
Its aim was to improve the health of people living in the Tauranga district, on North Island, through a capitation-based primary-care system - in effect, the polar opposite of the free-market direction the rest of New Zealand was heading in.
There are now eight such networks across the North Island, involving 300 doctors and 300 practice nurses, who provide a range of primary-care services for 500,000 patients.
In a comment that reflects public opinion in the country, Dr Pippa McKay of the New Zealand Medical Association says: "We are pleased that the competitive health model for publicly funded services - which we have long opposed - has gone."
The Republic has much to learn from New Zealand. With its new health strategy in place a year ahead of our own, it will be worth keeping a close eye on progress down under.
In News Features tomorrow, Maev-Ann Wren and Muiris Houston will provide an overview of the States of Health series and examine the best options for the Republic as the Government finalises its National Health Strategy