Primary Health Care Access and Ambulatory Sensitive Hospitalizations in New Zealand

Milne, Barry; Parker, Karl; McLay, Jessica; Randow, Martin von; Lay‐Yee, Roy; Hider, Phil; Cumming, Jacqueline; Davis, Peter

doi:10.1097/jac.0000000000000057

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…For example, a person identified as Chinese and Māori is labelled as Māori. Consistent with previous ASH research in NZ, 28 the cases with ‘no data’ for the childhood ASH variable in the merged file were assumed to have had no ASH events in the respective year and thus coded accordingly.…”

Section: Methodsmentioning

confidence: 99%

Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations

et al. 2022

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ObjectiveTo investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years.DesignObservational population-based study over 2008–2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases.SettingNew Zealand primary and secondary care.ParticipantsAll children aged 0–4 years enrolled in the PHO Enrolment Collection from 2008 to 2018.Main outcome measureASH.ResultsOnly 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables.ConclusionThe variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.

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Section: Methodsmentioning

confidence: 99%

Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations

et al. 2022

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“…Comparing the magnitude of ASH across countries using available estimates can be difficult, as ASH prevalence can substantially vary according to the definition used (there are a number of ASH condition sets available in the literature) [ 2 ]. However, there is some consistency in countries continuing to report relatively stable or increasing ASH over time despite efforts geared towards reducing these potentially avoidable hospital stays [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

et al. 2020

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Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224.

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“…PHC coverage can significantly reduce the strain on public hospitals and emergency departments by treating low-urgency conditions in the patient's community, therefore allowing a more efficient use of physical and human capital in the secondary health sector [30,87,88]. However, recent associational evidence from Europe contests the idea that primary care is less expensive, finding greater expenditure alongside better health outcomes in countries with stronger PHC systems, which the authors suggest might be due to the greater cost of maintaining decentralised administrative structures [89].…”

Section: The Importance Of Primary Health Carementioning

confidence: 99%

“…In New Zealand, previous analysis has approximated the substitution between primary and secondary care by examining how preventable hospitalisations changed as PHC subsidy coverage was progressively expanded under the PHCS [30]. Using administrative hospital data on ambulatory sensitive hospitalisations (ASH), the study finds that reductions in ASH rates did not neatly fit the direction of PHC subsidy rollouts, and disparities between more and less deprived communities widened over the study period.…”

Section: Secondary and Tertiary Service Usementioning

confidence: 99%

“…However, both earlier and more recent studies suggest inequities in access are ongoing, particularly for younger women, Māori and Pacific Peoples, and people living with chronic conditions [23,26,29]. Furthermore, the roll-out of PHC subsidies does not appear to have directly substituted ambulatory-sensitive demand for hospitals as hoped, and instead may play a more complex complementary role [30].…”

Section: Chapter 1: Introductionmentioning

confidence: 99%

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How has access to general practitioner services changed since the Primary Health Care Strategy 2001?

Thomson¹

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<p>With a governmental review of the health system impending, it is timely to examine whether the universal capitation-based subsidies engendered by the 2001 Primary Health Care Strategy have achieved and maintained their strategic goal of expanding access to general practitioners and reducing inequities. Prior scholarship finds evidence of reduced fees and increased consultation numbers and rates during the roll-out period, but the long-run picture remains unexplored, and there are multiple hitherto unexamined sources of endogeneity to unravel. This thesis addresses these gaps by examining New Zealand Health Survey data between 2002/03 and 2015/16. I examine the distribution of co-payments, utilisation and unmet need due to cost using regression modelling, accounting for endogenous self-reporting errors and selection effects through instrumentation and Heckman modelling, respectively. I propose a novel instrument to account for selection bias in self-reported fees, applicable in contexts where general practitioners play ‘gate-keeping’ roles for tertiary services. I find that the expanded universal subsidies were associated with improved access for Māori and more preventive visits as intended. However, patients with the greatest health need made far fewer doctors’ visits per annum than before. After providing universal subsidisation, the fees paid by high- and low-income groups also converged, and low-to-middle-income earners made more use of services but high-income earners did not. The higher rates of utilisation for both the whole population and for Māori have not survived in recent years. I discuss a range of possible explanations for these developments, with particular attention paid to the role of both the capitation subsidies and the subsequent Very-Low Cost Access price-capping scheme. This research contributes evidence to international scholarship on the link between universal healthcare subsidisation and equity of access, with attention to local nuances. It further provides domestic policymakers with an understanding of the contemporary scope and correlates of poor healthcare access ahead of the health system review.</p>

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Primary Health Care Access and Ambulatory Sensitive Hospitalizations in New Zealand

Cited by 6 publications

References 20 publications

Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations

Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations

GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

How has access to general practitioner services changed since the Primary Health Care Strategy 2001?

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