The price of ‘free’. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals
David Fearnley 1 , Ngaire Kerse 2 , Garry Nixon 31 Dunedin School of Medicine, New Zealand
2 School of Population Health, University of Auckland, New Zealand
3 Dunedin School of Medicine and Dunstan Hospital, New Zealand
Correspondence to: Garry Nixon, Clinical Senior Lecturer Rural Health, Deans Department, Dunedin School of Medicine, Rural Hospital Generalist, Dunstan Hospital, PO Box 30, Clyde, Central Otago, New Zealand. Email: garry.nixon@otago.ac.nz
Journal of Primary Health Care 8(3) 204-209 https://doi.org/10.1071/HC16014
Published: 20 September 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery.
AIM: The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents.
METHODS: A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated.
RESULTS: The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732.
DISCUSSION: This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.
KEYWORDS: Rural health; access to services; cost; New Zealand
References
[1] Rankin SL, Hughes-Anderson W, House AK, et al. Costs of accessing surgical specialists by rural and remote residents. ANZ J Surg. 2001; 71 544–7.| Costs of accessing surgical specialists by rural and remote residents.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvosFWnsA%3D%3D&md5=c5f079ac5f9f81f7d959342a88b7205cCAS | 11527266PubMed |
[2] Kernick DP, Reinhold DM, Netten A. What does it cost the patient to see the doctor? Br J Gen Pract. 2000; 50 401–3.
| 1:STN:280:DC%2BD3czptFSntA%3D%3D&md5=a1e943e0e2a45c5449e997f2362491ffCAS | 10897541PubMed |
[3] Gray AT, Huddart S. The real cost of attending Paediatric outpatients. Welsh Paed J. 2011; 35 46–9.
[4] Inland Revenue New Zealand.Mileage rate for self-employed people and reimbursing employees. [Cited 2016 July 24] Available from: www.ird.govt.nz/business-income-tax/expenses/mileage-rates/emp-deductions-allowances-mileage.html
[5] New Zealand Automobile Association. Time and distance calculator. [Cited 2016 July 24] Available from: www.aa.co.nz/travel/time-and-distance-calculator/
[6] Statistics New Zealand. [Cited 2016 July 24] Available from: www.stats.govt.nz
[7] Akobundu E, Ju J, Blatt L, Mullins CD. Cost of illness studies. Pharmacoeconomics 2006; 24 869–90.
| Cost of illness studies.Crossref | GoogleScholarGoogle Scholar | 16942122PubMed |
[8] Southern Regional Health Authority - Access to Care project, 1993–94.
[9] Loane MA, Oakley A, Rademaker M, et al. A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand. J Telemed Telecare 2001; 7 233–8.
| A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvmt1CnsA%3D%3D&md5=65e5d9401613d889eeb23ce564b604beCAS | 11506759PubMed |
[10] Oakley AM, Kerr P, Duffill M, et al. Patient cost-benefits of realtime teledermatology – a comparison of data from Northern Ireland and New Zealand. J Telemed Telecare 2000; 6 97–101.
| Patient cost-benefits of realtime teledermatology – a comparison of data from Northern Ireland and New Zealand.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3osVeqsw%3D%3D&md5=27ca67ee794360dcb45e3d4545effc1bCAS | 10824377PubMed |
[11] Hopley M, Horsburgh M, Peri K. Barriers to accessing specialist care for older people with chronic obstructive pulmonary disease in rural New Zealand. J Prim Health Care. 2009; 1 207–14.
| 20690384PubMed |
[12] Nixon G, Samaranayaka A, de Graaf B, et al. Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand. Health Policy. 2014; 118 222–8.
| Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand.Crossref | GoogleScholarGoogle Scholar | 24973925PubMed |
[13] Smith KB, Humphreys JS, Wilson MG. Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health. 2008; 16 56–66.
| Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research?Crossref | GoogleScholarGoogle Scholar | 18318846PubMed |
[14] Ministry of Health2016 New Zealand Health Strategy: Future direction. Wellington: Ministry of Health. [Cited 2016 July 24] Available from: www.health.govt.nz/publication/new-zealand-health-strategy-2016
