Are elected health boards an effective mechanism for public participation in health service governance?

There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision makingyet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear.Setting and participants This article discusses the experiences of New Zealand wheresince 2001there have been three sets of elections for District Health Boards. Information on candidates and election results is presented along with data gathered via post-election voter surveys. The article also considers the broader regulatory context within which the elected boards must operate.Discussion and conclusions The New Zealand experience illustrates that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections of 2001and non-voters form the majority. Reasons for not voting include failure to receive voting papersa lack of interestor no knowledge of elections. The elections have also failed to produce minority representationwhile the capacity for elected members to represent their communities is subject to constraints. On the upsideelections have enabled public involvement in various dimensions of participationincluding oversight and processes of governance. New Zealand's mixed performance suggests that elected boards may need to be complemented with other participatory channelsif increased public participation is the goal.