Assessing need for primary care services: analysis of New Zealand Health Survey data

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-'highneed' 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.

“Closed books”: restrictions to primary healthcare access in Aotearoa New Zealand—reporting results from a survey across general practices

“…We also know that the effects of the COVID-19 pandemic linger in general practice through the effects of delayed presentation, interrupted treatments, increases in demand from those who had COVID-19 and who want more care and increases in demands for mental health consultations, adding to the work of primary care providers. 19,20…”

“…VLCA and lower fees practices may need to keep their books open to remain financially sustainable, particularly as a result of the extra financial pressures in practices serving patients with high needs. 20,23 These findings underscore the need to carefully monitor healthcare access disparities, especially during times of healthcare reforms, to avoid unintentionally exacerbating inequities.…”

“…In California for example, practices disenrolled noncompliant patients to avoid low marks in clinical indicators used for quality assessments. 30 In Aotearoa New Zealand, there is concern that general practices are not enrolling higher-needs people where capitation formula are seen to not sufficiently compensate the higher costs associated with higher-needs enrolees, 20,23 and this experience is echoed internationally. 31 The study points at the breach of national enrolment policy: "No individual is to be refused enrolment on the basis of health status, anticipated need for health service or any form of discrimination" (p 5).…”

From the editors: challenges and opportunities for sustainable and equitable primary care

“…Using the New Zealand Health Survey, 5 Hau and colleagues have shown that 'high needs' patients are likely to suffer from multimorbidity, require seven or more GP visits per year, and report barriers to access. 6 On a very similar note, Dowell and colleagues have used routinely collected primary care data to demonstrate that health risk factors and co-morbidities are clustered in a small number of practices with many 'high needs' patients. Considerable challenges, but also opportunities, are afforded to general practice by both the COVID-19 pandemic and the health reforms.…”

Health Reform in Aotearoa New Zealand: Insights on Health Equity Challenges One Year On

“…Māori health providers have been under-funded since their inception [ 4 ], although the majority of Māori (and Pasifika) patients are enrolled in ‘traditional’ (GP-led and owned) practices [ 32 ], and the under-funded nature extends across the primary healthcare sector. This underfunding is particularly evident for those providers that care for high-needs populations (which includes Māori and Pasifika patients) [ 32 – 34 ]. Evidence has been submitted to Wai 2575 to quantify the direct under-funding so to inform compensation discussions and the cost of the inequality caused by lack of access to primary care services for Māori [ 35 ].…”