This thesis investigates the impediments to access engendered by the government's decision to reduce public funding to health care and incorporate market principles in the financing process. The critique begins with competitive markets and their application to the provision of health care. The intent is not to argue along the lines of 'state verse the market' but rather to explicate the fundamental changes which are going on in the thinking of government and policy makers today in respect to their approach toward providing health care. Against this background the implications of these fundamental changes are assessed on a rapidly growing group in New Zealand, the elderly.

An empirical study of the elderly is conducted in order to validate both the micro and macro issues raised in this thesis. The macro issues focus on the effectiveness of market reforms and the issue of access for the elderly, while the micro issues relate to the reality of private sector involvement for the elderly.

The conclusions to be drawn from the thesis are threefold. First, the involvement of the private sector in providing health care has created fundamental access problems for the elderly. If the current political mandate in health care is followed then this will manifest into an even greater problem in the next millennium. Second the reduction of the state's role in financing health care is creating uncertainty and financial pressure on the elderly. Third, the private insurance market is not suitable as a provider of essential health care services required by the elderly in New Zealand.