In the early 2000’s, the New Zealand government made some changes to health policy in an effort to iron out some of the inequities of our health system. Universal subsidies for general practice services were brought in. The cost of GP visits were reduced. And subsequently the number of GP visits increased, showing that these measures were effective in reducing inequities in access.

However, the initial increase in GP visits left the system struggling to keep up with demand, leaving many in poor health unable to access a doctor.

New research has taken a closer look at the reforms and concluded that policy makers need to consider how changes to increase access will affect providers.

The research was carried out by Victoria University of Wellington’s Master’s student Michael Thomson under the supervision of Professor Jacqueline Cumming, Director of the University’s Health Services Research Centre. It was published in the international journal Health Policy.

The study analysed data from the Ministry of Health’s New Zealand Health Survey collected before and after policy reforms in the early 2000’s that were designed to improve primary healthcare access for New Zealanders.

“My study showed people with poor health reported fewer visits after the reforms, which might mean GPs were less readily available due to the increased visits by others,” says Thomson.

“Early evaluations of these policy changes suggested they were successful at improving access to doctors. For example, my study shows Māori were much less likely to visit GPs than New Zealand Europeans with similar health and social characteristics before the reforms, and this improved in the years immediately following the policy changes, suggesting the policy did lead to better access to GPs for Māori patients.”

“However, data I analysed from 2011-2012 to 2015-2016 showed Māori visit numbers went back down to pre-policy change levels, so the success from the initial policy changes wasn’t sustained.”

“My research shows that Māori are still facing barriers to accessing GPs, despite initial improvement, and that subsidies need to be one part of a bigger scheme to improve healthcare access for those who need it most. This work also observes changes over a longer period of time than previous studies, providing a more in-depth look at the effects of policy change on GP visits.”

Thomson says policy-makers need to consider a raft of factors when bringing in changes to increase accessibility.

“Policy-makers need to tackle cost barriers to GPs in packages that are well-coordinated with other objectives, like reducing waiting times and getting good value for money. For example, this could mean helping providers to increase their workforce and organise themselves more efficiently or targeting subsidies where they’re needed most.”


  1. Have lessons really been learned? Health policy changes also need to factor in continuum of care, sustained capacity building (through an equity lens) and strong, capable leadership that understands the governments treaty obligations.


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