Assessing need for primary care services: analysis of New Zealand Health Survey data
Kenny Hau
1 * , Jacqueline Cumming 2 , Maite Iruzun Lopez 2 , Mona Jeffreys 2 , Tessa Senior 2 , Peter Crampton 1
1 Centre for Hauora Māori, University of Otago, PO Box 56, Dunedin, New Zealand.
2 Te Hikuwai Rangahau Hauora | Health Services Research Centre; Te Herenga Waka‐Victoria University of Wellington, Wellington, New Zealand.
Journal of Primary Health Care 14(4) 295-301 https://doi.org/10.1071/HC22037
Published: 2 November 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: The 2001 Primary Health Care Strategy provided significant new government funding for primary care (general practice and related services) via capitation funding formulas. However, there remain important unanswered questions about how capitation funding formulas should be redesigned to ensure equitable and sustainable service provision to all population groups.
Aim: To compare levels of chronic illness, utilisation, and unmet need in patients categorised as ‘high-need’ with those categorised as non-‘high-need’ using the definitions that are used in the current funding context, in order to inform primary care funding formula design.
Methods: Respondents of the New Zealand Health Survey (2018–19) were categorised into ‘high-need’ and non-‘high-need’, as defined in current funding formulas. We analysed: (i) presence, and number, of chronic diseases; (ii) self-reported primary care utilisation (previous 12 months); and (iii) self-reported unmet need for primary care (previous 12 months). Analyses used integrated survey weights to account for survey design.
Results: In total, 29% of respondents were ‘high-need’, of whom 50.2% reported one or more chronic conditions (vs 47.8% of non-‘high-need’ respondents). ‘High-need’ respondents were more likely than non-‘high-need’ respondents to: report three or more chronic conditions (14.4% vs 13.7%); visit a general practitioner more often (seven or more visits per year: 9.9% vs 6.6%); and report barriers to care.
Discussion: There is an urgent need for further quantification of the funding requirements of general practices serving high proportions of ‘high-need’ patients in order to ensure their viability, sustainability and the provision of quality of care.
Keywords: capitation funding, chronic illness, general practice, health care utilisation, health equity, high-need, primary care.
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