Social equity and primary healthcare financing: lessons from New Zealand
Jonathan FoleyWestcott Partners, 8705B Colesville Road, #293, Silver Spring, MD 20910, USA. Email: jfoley5east@gmail.com
Australian Journal of Primary Health 24(4) 299-303 https://doi.org/10.1071/PY17153
Submitted: 24 October 2017 Accepted: 13 April 2018 Published: 30 July 2018
Abstract
This paper reviews the effect of a primary care financing scheme introduced in New Zealand as a component of the New Zealand Primary Health Care Strategy, a comprehensive reform of the way that primary healthcare was governed, financed and delivered. The population-based funding formulae incorporated an area-based measure of social deprivation and ethnicity in an explicit attempt to improve access to care for certain population groups and fund social interventions aimed at addressing conditions that lead to improved health outcomes. The New Zealand experience shows that introducing a nationwide, comprehensive program to improve access and reduce health disparities is possible. However, the effect of this effort on reducing health disparities is not entirely clear because success ultimately relies on local implementation of a complex set of interventions that need to be evaluated more rigorously. In addition, the partial subsidies for first contact care that came with the Strategy have been shown to improve access, but, the success of this approach relies on compliance by private-practising general practitioners with a fee reduction regimen, which is subject to local variation.
References
Atkinson J, Salmond C, Crampton P (2014) NZDep2013 Index of Deprivation. (Department of Public Health, University of Otago: Wellington, New Zealand) Available at http://www.otago.ac.nz/wellington/otago069936.pdf [Verified 3 June 2018]Booth M, Hill G, Moore MJ, Dalla D, Moore MG, Messenger A (2016) The new Australian Primary Health Networks: how will they integrate public health and primary care? Public Health Research & Practice 26, e2611603
| The new Australian Primary Health Networks: how will they integrate public health and primary care?Crossref | GoogleScholarGoogle Scholar |
Breslin E, Lambertino A, Heaphy D, Dreyfus T (2017) Medicaid and social determinants of health: adjusting payment and measuring health outcomes. (Health Management Associates: Lansing, MI, USA) Available at http://www.statenetwork.org/wp-content/uploads/2017/07/SHVS_SocialDeterminants_HMA_July2017.pdf [Verified 3 June 2018]
CBG Health Research Limited (2004) Care Plus process report. (NZMOH: Wellington, New Zealand) Available at https://www.health.govt.nz/system/files/documents/pages/careplusprocessreportmar04.pdf [Verified 3 June 2018]
Croxson B, Smith J, Cumming J (2009) Patient fees as a metaphor for so much more in New Zealand’s primary health care system. (Health Services Research Centre, Victoria University of Wellington: Wellington, New Zealand) Available at http://www.victoria.ac.nz/sog/researchcentres/health-services-research-centre/docs/reports/Patient-Fees-Sept-2.pdf [Verified 3 June 2018]
Cumming J, Gribben B (2007) Evaluation of the primary health care strategy: practice data analysis 2001–2005. (CBG Health Ltd: Auckland, New Zealand) Available at http://www.cbg.co.nz/site/cbg/PHCSE-FINAL.pdf [Verified 3 June 2018]
Cumming J, Raymont A, Gribben B, Horsburgh M, Kent B, McDonald J, Mays N, Smith J, Boustead C, Coupe N, Fa’alau F, Churchward M, Barnett P, Croxson B, Goodhead A, Paurini M, Perera R, Rauyinar D, Green T, Dowell T (2005) Evaluation of the implementation and intermediate outcomes of the primary health care strategy: first report: overview. (Health Services Research Centre, Victoria University Press: Wellington, New Zealand) Available at https://www.victoria.ac.nz/health/centres/health-services-research-centre/docs/reports/downloads/FINAL-Overview-27-May.pdf [Verified 3 June 2018]
Dowell AC, Garrett S, Collings S, McBain L, McKinlay E, Stanley J (2009) Evaluation of the primary mental health initiatives: summary report 2008. (University of Otago and Ministry of Health: Wellington, New Zealand) Available at https://www.health.govt.nz/system/files/documents/publications/evaluation-primary-mental-health-initiatives-summary-report-jul09.pdf [Verified 3 June 2018]
Marriott L, Sim D (2014) Indicators of Inequality for Māori and Pacific People (Victoria University: Wellington, New Zealand) Available at http://www.victoria.ac.nz/sacl/about/cpf/publications/working-papers/WP09_2014_Indicators-of-Inequality.pdf [Verified 3 June 2018]
New Zealand Ministry of Health (2001) Primary health care strategy. (NZMOH: Wellington, New Zealand) Available at https://www.health.govt.nz/system/files/documents/publications/phcstrat.pdf [Verified 3 June 2018]
New Zealand Ministry of Health (2003) Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980–1999 (NZMOH: Wellington, New Zealand) Available at http://www.moh.govt.nz/notebook/nbbooks.nsf/0/37A7ABB191191FB9CC256DDA00064211/$file/EthnicMortalityTrends.pdf [Verified 3 June 2018]
New Zealand Ministry of Health (2004) A portrait of health: key results of the 2002–03 New Zealand health survey. (NZMOH: Wellington, New Zealand) Available at http://www.moh.govt.nz [Verified 3 June 2018]
New Zealand Ministry of Health (2005) Decades of disparity II: socioeconomic mortality trends in New Zealand, 1981–1999. (NZMOH: Wellington, New Zealand) Available at http://www.rangahau.co.nz/assets//decades_disparity/disparities_report2.pdf [Verified 3 June 2018]
New Zealand Ministry of Health (2008) Intersectoral community action for health (ICAH) evaluation: an overview. (NZMOH: Wellington, New Zealand) Available at https://www.health.govt.nz/system/files/documents/publications/icah-final-mar08.pdf [Verified 3 June 2018]
Phillips RL, Liaw W, Crampton P, Exeter D, Bazemore A, Vickery KD, Petterson S, Carrozza M (2016) How other countries use deprivation indices – and why the united states desperately needs one. Health Affairs 35, 1991–1998.
| How other countries use deprivation indices – and why the united states desperately needs one.Crossref | GoogleScholarGoogle Scholar |
Primary Care Working Group on General Practice Sustainability (2015) Report to the Minister of Health. (General Practice New Zealand: Wellington, New Zealand) Available at http://gpnz.org.nz/wp-content/uploads/PCWG-General-Practice-Sustainability-Public-Report.pdf [Verified 3 June 2018]
Sheridan NF, Kenealy TW, Connolly MJ, Mahony F, Barber PA, Boyd MA, Carswell P, Clinton J, Devlin G, Doughty R, Dyall L, Kerse N, Kolbe J, Lawrenson R, Moffitt A (2011) Health equity in the New Zealand health care system: a national survey. International Journal for Equity in Health 10, 45
| Health equity in the New Zealand health care system: a national survey.Crossref | GoogleScholarGoogle Scholar |
Smith J (2009) ‘Critical Analysis of the Implementation of the Primary Health Care Strategy Implementation and Framing of Issues for the Next Phase.’ (The Nuffield Trust: London, UK)
World Health Organization (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. WHO, Geneva, Switzerland.
