There are 300,000 people in Aotearoa New Zealand not enrolled with a primary healthcare organisation (PHO) and the situation is only likely to worsen as GP shortages grow, say Te Herenga Waka—Victoria University of Wellington researchers.
A new study by the University’s Health Services Research Centre Te Hikuwai Rangahau Hauora shows about 6 per cent of the population are not enrolled in a PHO.
There are striking inequities in primary healthcare enrolment across socio-demographic groups and district health boards (DHBs), says the study.
Young people (15–24 years) are the least likely to be enrolled. Māori also have lower enrolment rates than New Zealand European/Other groups.
The most affluent areas have the highest enrolment rates, while Auckland DHB shows the lowest.
Co-author Dr Maite Irurzun Lopez, a senior research fellow at the Centre, which is in the Wellington Faculty of Health Te Wāhanga Tātai Hauora, says one of the contributing factors may be ‘closed books’ in GP practices unable to take on new patients.
“This is a real issue that’s only going to get bigger and bigger as more GPs retire,” says Dr Lopez.
She says people whose local GPs are closed to enrolment are disadvantaged, given the higher cost of accessing primary healthcare for non-enrolled patients, as well as through after-hours clinics.
Co-author Dr Mona Jeffreys, also a senior research fellow at the Centre, says cost of healthcare in general is “a huge issue across the board for everyone”, but is more likely to affect young people, those on low incomes, and women who might be prioritising their children’s care.
Other implications include a cost impact on the hospital care system if people are not getting adequate primary care, because they may use over-burdened accident and emergency services at public hospitals or, if their health deteriorates, end up being admitted to hospital.
“The cost of providing hospital care is much more expensive,” says Dr Jeffreys.
“The proportion of New Zealanders not enrolled has worsened slightly since 2015 and we have a bigger problem coming,” she says.
Dr Lopez says data collected by Stats NZ needs to be refined and used more effectively by the Ministry of Health to measure enrolments more accurately and track inequities in healthcare access.
“If we are serious about making primary health care work, we need to improve how we track progress with the information we have available. If people are not enrolled, that means they are not benefiting from things like paying lower fees or accessing services around health promotion. It also means the vision for the primary healthcare strategy set in 2001 is unable to be realised.”
Inequities in access and differences between certain demographics and communities have been widening over time rather than reducing—”a sign we need to work these things out”, she says. “These groups are only going to suffer more.”
Given the momentum in New Zealand for reforming health policies, including the Health and Disability Review and the Waitangi Tribunal Health Services and Outcomes Inquiry (Wai 2575), now is a good time to be asking these questions to determine if primary healthcare is doing what it should, she says.
“Having all eligible population enrolled is the first step to be able to monitor population health.”
Further work is needed to understand why people are not enrolled and the associated impacts. This is particularly important for groups such as Māori and younger populations where inequities in healthcare access have been identified, says Dr Lopez.
“We need to look at differences in health outcomes for those enrolled and not enrolled.”
Dr Jeffreys says a health system needs to be culturally as well as physically accessible.
“And for a lot of people it’s not. Why would you bother enrolling with a service you know is not going to meet your needs?”
She says the proposed Māori Health Authority needs to have the power and resources to commission services to maximise the chance of changing health outcomes for Māori, but it is not yet clear whether this will be implemented as part of the proposed changes to the health system.
The study was supported by a Health Research Council of New Zealand ‘Enhancing Primary Health Care Services to Improve Health in Aotearoa/New Zealand’ grant.