Cost key to accessing primary health care in NZ

Friday 3 July 2009

Cost the key to accessing primary health care in NZ

Cost has been a major factor in causing thousands of New Zealanders to defer primary health care treatment according to a new study by the University of Otago Wellington.

The study by Dr Santosh Jatrana and Professor Peter Crampton shows that in 2004/5 there were significant financial barriers to people accessing GPs, prescriptions and dental care, and this was probably having an effect on the general and dental health of New Zealanders.

The study of over 18,000 people entitled Primary health care in New Zealand has recently been published in the international journal Health Policy. The data came from the Statistics NZ Survey of Family, Income, Employment and Health (SoFIE-Health) and carried out in 2004/5.

It shows that 16% of respondents at that time deferred visiting a GP, 23% put off going to the dentist and 7% deferred picking up a prescription in the last 12 moths. This was even though the primary sector was 60% funded by the Government at the time of the study.

“Cost barriers make access to primary health care unaffordable for those with fewer financial resources,” says Dr Santosh Jatrana. “A key policy lever is to provide primary health care free or to make co-payments sufficiently low that people are able to seek primary health care unimpeded by cost barriers.”

However subsequent increased GP subsidies by the Labour Government in 2007 led to a reduction in costs to patients from an average of $50 a visit to $25 or less. Although the system still required patients be enrolled with a GP or PHO to take advantage of the increased subsidy, and the same applied to prescription charges.

“The increased subsidy probably means fewer people today are having problems accessing their GP or prescriptions, but that won’t become clear until the next wave of SoFIE-Health data collected in 2006-07 to be analysed in the next couple of years ,” says Dr Jatrana.

Regarding dental care, public funding contributes only approximately 25% of dental costs in NZ unlike some overseas jurisdictions, and is concentrated on children and adolescents and some hospital dental facilities.

This results in much higher incidence of not visiting a dentist than a doctor or collecting a prescription. The researchers say this is of concern because poor or deteriorating oral health is often associated with other illnesses, poor quality of life and economic deprivation.

Interestingly in 2004/5 the most likely people to defer primary care due to financial barriers were: women, those with more individual deprivation characteristics (5+) and those reporting the worst health status in terms of high levels of psychological distress and having more than two other diseases.

The authors conclude that lowering costs of primary health, particularly dental care is the most important factor in improving accessibility. They also point out that deferred primary care increases long term clinical costs through increased admission to hospitals with chronic illness. Timely access is a fundamental and well established determinant of good health outcomes in an economically productive society they say.

This study was funded by the Health Research Council, University of Otago, ACC, and ALAC.

ENDS