The Ministry of Health is responsible for the oversight and funding of the twenty district health boards (DHBs). These are responsible for organising healthcare in the district and meeting the standards set by the Ministry of Health. Twenty-one DHBs came into being on 1 January 2001 with Southland and Otago DHBs merging into Southern DHB on 1 May 2010. The boards for each district health board are elected in elections held every three years, with the exception of one of the eight board members, who is appointed by the Ministry of Health. The DHBs oversee the forty-six primary health organisations established throughout the country. These were first set up in July 2002, with a mandate to focus on the health of communities. Originally there were 81 of these, but this has been reduced down to 46 in 2008. They are funded by DHBs, and are required to be entirely non-profit, democratic bodies that are responsive to their communities' needs. Almost all New Zealanders are enrolled in a PHO, as there are financial incentives for the patients to become enrolled. The Northern Region DHBs also use shared services provided by the Northern DHB Support Agency and HealthAlliance. These services deliver region-wide health initiatives and shared IT services and logistics. The Canterbury District Health Board has been successful in redesigning services to reduce hospital use. Some of this transformation was precipitated by the 2011 Christchurch earthquake when several healthcare buildings were damaged or destroyed. It now has lower rates of acute medical admissions, low average lengths of stay, fewer readmissions in acute care, fewer cancelled planned admissions and more conditions treated out of hospital. Hospital and specialist care in New Zealand is totally covered by the government if the patient is referred by a general or family practitioner and this is funded from government expenditure (approx. 77%). Private payment by individuals also plays an important role in the overall system although the cost of these payments are comparatively minor. Those earning less than certain amounts, depending on the number of dependents in their household, can qualify for a Community Services Card (CSC). This reduces the cost of after-hours doctors' visits, and prescription fees, as well as the cost of visits to a person's regular doctor. Injuries which occur as a result of "accidents", ranging from minor to major physical but including psychological trauma from sexual abuse are generally covered by the Accident Compensation Corporation (ACC). This may include coverage for doctors visits and lump-sum payments. In New Zealand's public health system it is typical for medical appointments, particularly surgeries to have a waiting list.