In a report to be considered by the Otago District Health Board today, the chief executive of both provinces' boards has stuck with a controversial single-PHO proposal to replace the existing nine.
"Other options may appear desirable, but compromise a regional whole-of-population approach to primary care," he says in his latest report.
At a special joint meeting of the boards in August, it became clear there would not be consensus on Mr Rousseau's proposal, and his recommendation was not put to a vote.
Instead, Mr Rousseau was asked to consider the matter further and report to a future meeting.
His new report does not contain financial information, although he has previously said having one PHO would save $1 million in administration costs.
Existing PHOs continue to be critical of the proposal.
Two other possibilities, a PHO comprising the four existing Southland PHOs, and a new rural-based PHO covering both province's rural areas, have been suggested by some of them.
Mornington PHO, the only single-practice PHO in the regions, has written to the board expressing concern that removal of its PHO status will limit its ability to participate in the process to become Otago's first integrated family-care centre. (These are centres where a variety of services are provided on one site.)
The board has been advised by South Link Health, which had its own super PHO proposal, that general practice owners, who covered almost 64% of enrolled patients, supported having one PHO.
Mr Rousseau said the support for a single PHO was particularly strong among Southland practice owners, with about 77% support.
Over time, the single PHO would assume responsibility for supporting and funding most community service health-care providers, Mr Rousseau said.
This was a fundamental shift from the existing arrangement where funding of such services was arranged by the district health boards.
Mr Rousseau said some great things had been achieved by some of the existing PHOs, but they were only benefiting certain groups and "inadvertently, we could be accused of creating health inequalities among our population".
The board was required to consider the whole population - "pockets of excellence are commendable, but we need to focus on obtaining excellence everywhere".
Mr Rousseau also dismissed the idea of several PHOs working under one management services company.
This would be restricted by the many autonomous groups that would be required to reach consensus on every regional decision.
Board managers acknowledged the many concerns raised about change, especially the need to recognise communities of interest and the views of community health-care providers.
The model proposed would have three tiers: a regional level, communities of interest or local area (covering three areas, greater Invercargill, rural Otago and Southland, and greater Dunedin), and a local service-delivery level containing all those providing health-care services.
While the budget would be managed at the regional level, those at the local level would have discretionary budgets to meet the specific needs of their local communities.
The services would be responsible for innovation and access to discretionary and innovation spending, including moves to integrated family-care centres.
Mr Rousseau's report contains five recommendations, including approving the one PHO proposal, declining all present and new proposals for new PHOs, and approving exit notices to all existing PHOs once a timeline for the establishment of the new PHO is confirmed.
Board chairman Errol Millar has advised he plans to allow the PHO discussion in the public section of the meeting, but will be asking the board to make its decision in secret and embargo it for a week to allow the Southland board to deliberate without undue pressure from Otago.
The boards were to have held another joint meeting about the issue, but a suitable time could not be arranged.
