The document, obtained this week by Labour, comes from the office of the Director-general of Health Chai Chuah, and reveals various health board governance proposals.
These include reducing boards from 11 to nine members, with six Government appointees and the other three drawn from an elected advisory board for six-month stints.
(At present, seven members are voted in at local government elections and four appointed are by the Health Minister).
The proposals are certainly significant.
Labour (which in coalition with Alliance overhauled the health system in the early 2000s, including the formation of locally elected district health boards) has slammed the proposals as underhand and undemocratic.
Health Minister Jonathan Coleman's comments that the proposals are ''not Government policy'', have been made by a ''third party'', and have not been read by him (despite the documents being sent to the chief executives and chairmen of the country's 20 district health boards) only add to the feeling of unease - even if he has also said changes to DHB governance are unlikely.
(After all, southerners' experience is of a minister who in April rejected persistent rumours the Government intended to replace the embattled Southern DHB with a commissioner, before doing so in June.)
Given this, the public and critics may be excused for wondering whether the minister is distancing himself for a reason.
The possibility of substantial changes being thrust on the public is unsettling, and the implications of stealth and a possible agenda are emotive.
But are they fair?
The leaked document is in fact part of two reviews of the health sector taking place as the Government updates the New Zealand Health Strategy of 2000.
The Ministry of Health is leading the update, with support from external reviewers.
The two reviews are considering funding and ''capability and capacity'' (defined as governance, leadership, management and delivery).
Mr Chuah is considering the recommendations before a draft strategy is given to Dr Coleman and then made available for consultation.
Given the context, Dr Coleman is playing semantics by calling the reviews ''third party'', but as the process is only partially complete, it is perhaps not unexpected he has not seen the recommendations or draft strategy yet (although it does seem strange some proposals have been sent to the DHBs before the minister has seen them).
Looking at the issue dispassionately, in a time of rapid technological change, spiralling demands in the health sector (and given the ongoing financial difficulties for the SDHB as just one example), a sector review is not only vital, but the responsible thing for the Government to undertake. Whether the current governance model is working should absolutely be part of such a review.
It is essential, however, that the strategy considers other pressing issues, including the population-based funding model, long criticised as unfair to the South.
This newspaper has previously referred to that funding model as the elephant in the room.
It must be taken into consideration, or the fear will be that there is an agenda based simply around cost cutting and centralisation, which is likely to result in the loss or reduction of services.
It would make sense - and is to be hoped - any information on the SDHB and reasons for its financial woes that can be garnered by recently installed commissioner Kathy Grant will also be taken into account as part of the strategy.
And it is also vital that, once the draft strategy is complete, there be the chance for meaningful consultation on the recommendations, frank discussion about the future of the health sector - and the best way to ensure the healthiest possible outcome for the public.
