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Introduction In Aotearoa New Zealand, being enrolled with a Primary Health Care (PHC) provider furnishes opportunities for lower cost access to PHC, preventative care and secondary health care services, and provides better continuity of care. We examine the characteristics of populations not enrolled, and whether enrolment is associated with amenable mortality. Method We retrieved records of all deaths registered 2008 to 2017 in Aotearoa New Zealand, which included demographic and primary cause of death information. Deaths were classified as premature (aged under 75 years) or not, and amenable to health care intervention or not. The Primary Health Organisation (PHO) Enrolment Collection dataset provided the PHC enrolment status. Logistic regression was used to estimate the risk of amenable deaths by PHO enrolment status, adjusted for the effects of age, sex, ethnicity and deprivation. Results A total of 308,628 mortality records were available. Of these, 38.2% were premature deaths, and among them 47.8% were amenable deaths. Cardiovascular diseases made up almost half of the amenable deaths. Males, youths aged 15–24 years, Pacific peoples, Māori and those living in the most socio-economically deprived areas demonstrated a higher risk of amenable mortality compared to their respective reference category. One in twenty (4.3%) people who had died had no active enrolment status in any of the calendar years in the study. The adjusted odds of amenable mortality among those not enrolled in a PHO was 39% higher than those enrolled [Odds Ratio = 1.39, 95% Confidence Interval 1.30–1.47]. Implications Being enrolled in a PHC system is associated with a lower level of amenable mortality. Given demonstrated inequities in enrolment levels across age and ethnic groups, efforts to improve this could have significant benefits on health equity.

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Background: Capitation formulas take into account the characteristics of the population served as a way of estimating the funding required to meet varying levels of need. Capitation is a well-established method of funding health care in many different counties, especially in primary care. In Aotearoa New Zealand (ANZ), a capitation formula has been used since 2002 to fund all general practices. However, general practices who service greater numbers of people with complex health needs may not be funded adequately using the current formula if the characteristics used in the formula do not appropriately reflect the varying needs of those enrolled. We sought to quantify the levels of funding received by general practices who serve high proportions of high needs people, in order to assess if general practices are adequately funded to do so. Method: Ministry of Health enrolment data was used to inform the demographic spread of five hypothetical 5,000 patient practices consisting of: 30%, 50%, 70%, 90% and 100% high needs people. High needs were defined as those who fit one or more of these three criteria: Māori ethnicity; Pacific ethnicity; and people residing in an area of high socioeconomic deprivation. Annual first level services payments, High User Health Card, and additional funding streams including Very Low-Cost Access, Community Service Cards (CSC) and Fees-free for under 14s were taken from the Primary Health Organisation Services Agreement contract to calculate levels of income for all hypothetical practices. Results: Age is a strong determinant of capitation funding. Practice level funding does not increase in proportion to the level of needs of the populations served. VLCA funding is higher for the 70% high need then the 90% high need practice. CSC and Fees-free under 14s funding increase as the percentage of high needs people increase but not proportionally to the level of need. Conclusion: Use of age and sex as the main determinants for capitation funding shows evidence of structural discrimination within the health system. Funding schemes aimed at helping high needs populations do not always result in adequate funding for general practices to serve these communities well.