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New Zealand’s Primary Health Care Strategy: early effects of the new financing and payment system for general practice and future challenges

Published online by Cambridge University Press:  30 October 2009

Jacqueline Cumming  and
Nicholas Mays
Jacqueline Cumming*
Affiliation:
Director, Health Services Research Centre, School of Government, Victoria University of Wellington, Wellington, New Zealand
Nicholas Mays
Affiliation:
Professor of Health Policy, Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKHealth Services Research Centre, School of Government, Victoria University of Wellington, New Zealand
*
Correspondence to: Jacqueline Cumming, Director, Health Services Research Centre, School of Government, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand. Email: [email protected]
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Abstract

Since 2001, implementation of a New Zealand’s Primary Health Care Strategy (the Strategy) has led to an increase in the proportion of primary health care services which are publicly funded, the development of 82 primary health organisations (PHOs) to oversee primary health care services and universal public capitation funding of PHOs. This approach has replaced the previous system of fee-for service targeted public subsidies paid to individual general practitioners (GPs). Patient copayments, although at a reduced level but still set by individual practitioners, have remained a core feature of the system.

This paper focuses on the implementation and impact of key policy changes over the first five years of the Strategy. Although patient copayments have fallen and consultation rates have increased, the new funding and payment system has raised a number of unresolved issues – whether to retain the new universal funding system or revert to the former targeted approach; how to achieve the potential gains from capitation when GPs continue to receive their income from a variety of sources and in a variety of different ways; and how to manage the potential for ‘cream skimming’.

Recent improvements in access may, in time, improve health status and reduce inequalities in health, but there is no guarantee that a universal system will necessarily improve average health or reduce inequalities. Much depends on the services being delivered and the populations that are benefiting most – something New Zealand needs better evidence on before determining future policy directions in primary health care.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 1 , 26 January 2011 , pp. 1 - 21
Copyright
Copyright © Cambridge University Press 2009

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References

Ajwani, S., Blakely, T., Robson, B., Tobias, M.Bonne, M. (2003), Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980–1999, Wellington: Public Health Intelligence.Google Scholar
Boston, J.St John, S. (1999), ‘Targeting Versus Universality: Social Assistance for All or Just for the Poor?’, in J. Boston, P. Dalziel and S. St John (eds), Redesigning the Welfare State in New Zealand: Problems, Policies, Prospects, Auckland: Oxford University Press: 93–113.Google Scholar
Coster, G.Gribben, B. (1999), ‘Primary Care Models for Delivering Population Based Health Outcomes’, Discussion Papers on Primary Health Care, National Advisory Committee on Health and Disability, Wellington.Google Scholar
Crampton, P. (1999), ‘Third Sector Primary Health Care’, Discussion Papers on Primary Health Care, National Advisory Committee on Health and Disability, Wellington.Google Scholar
Crampton, P., Salmond, C.Kirkpatrick, R. (2004), Degrees of Deprivation in New Zealand: An Atlas of Socioeconomic Difference, Auckland: David Bateman Ltd.Google Scholar
Crengle, S. (1999), ‘Māori Primary Care Services’, Discussion Papers on Primary Health Care, National Advisory Committee on Health and Disability, Wellington.Google Scholar
Croxson, B., Smith, J.Cumming, J. (2009), Patient Fees As a Metaphor for So Much More in New Zealand’s Primary Health Care System, Wellington: Health Services Research Centre.Google Scholar
Cumming, J. (1999), ‘Funding Population-Based Primary Health Care in New Zealand’, Discussion Papers on Primary Health Care, National Advisory Committee on Health and Disability, Wellington.Google Scholar
Cumming, J., Goodhead, A., Barnett, P., Walker, T., Clayden, C., Churchward, M., Simonsen, K., Ashton, T., Boulton, A., Russell, M., Perera, R., Fa’alau, F., Asiasiga, L., Cunningham, C., Lungley, S., Murphy, C., Cochrane, M., French, S.Davis, J. and the Health Reforms 2001 Research Team (2003), Interim Report on Health Reforms 2001 Research Project, Wellington: Health Services Research Centre.Google Scholar
Cumming, J.Gribben, B. (2007), Evaluation of the Primary Health Care Strategy: Practice Data Analysis 2001–2005, Wellington: Health Services Research Centre.Google Scholar
Cumming, J.Mays, N. (2002), ‘Reform and counter-reform: how sustainable is New Zealand’s latest health system restructuring?’, Journal of Health Services Research and Policy, 7, Supplement 1: 46–55.CrossRefGoogle ScholarPubMed
Cumming, J., Mays, N.Gribben, B. (2008), ‘Reforming primary health care: is New Zealand’s Primary Health Care Strategy achieving its early goals?’, Australia and New Zealand Health Policy, 5: 24.CrossRefGoogle ScholarPubMed
Cumming, J., Raymont, A., Gribben, B., Horsburgh, M., Kent, B., McDonald, J., Mays, N., Smith, J. (2005), Evaluation of the Implementation and Intermediate Outcomes of the Primary Health Care Strategy, First Report, Wellington: Health Services Research Centre.Google Scholar
Gauld, R. (2001), Revolving Doors: New Zealand’s Health Reforms, Wellington: Institute of Policy Studies and the Health Services Research Centre.Google Scholar
Gosden, T., Forland, F., Kristiansen, I. S., Sutton, M., Leese, B., Giuffrida, A., Sergison, M.Pedersen, L. (2001), ‘Impact of payment method on behaviour of primary care physicians: a systematic review’, Journal of Health Services Research and Policy, 6(1): 44–55.CrossRefGoogle ScholarPubMed
Hay, I. (1989), The Caring Commodity: The Provision of Health Care in New Zealand, Auckland: Oxford University Press.Google Scholar
Health Benefits Review (1986), Choices for Health Care: Report of the Health Benefits Review, Wellington: Health Benefits Review.Google Scholar
Health Funding Authority (1998), The Next Five Years in General Practice, Auckland: Health Funding Authority, Northern Office.Google Scholar
Health Services Assessment Collaboration (2008), The Effectiveness of Interventions for Reducing Ambulatory Sensitive Hospitalisations: A Systematic Review, Christchurch: Health Services Assessment Collaboration.Google Scholar
Health Workforce Advisory Committee (2005), Fit for Purpose and for Practice: A Review of the Medical Workforce in New Zealand: Consultation Document, Wellington: Ministry of Health.Google Scholar
Hefford, M., Crampton, P.Foley, J. (2005), ‘Reducing health disparities through primary care reform: the New Zealand experiment’, Health Policy, 72(1): 9–23.CrossRefGoogle ScholarPubMed
Howell, B. (2008), ‘Capitation and financial risk allocation in New Zealand’s primary health care sector: the perverse consequences of neglecting financial risk allocation’, Agenda, 15(1): 29–48.Google Scholar
King, A. (2001), The Primary Health Care Strategy, Wellington: Ministry of Health.Google Scholar
King, A. (2004), Memorandum to Cabinet: Primary Health Care Strategy – Achieving Low Cost Access. http://www.moh.govt.nz/moh.nsf/pagesmh/5531/$File/CabinetPaperLowCostAccess.pdf [8 October 2009].Google Scholar
King, A. (2005), Media Release: Primary Health Money rolled out to 18–24-year-olds.Google Scholar
Management Research Centre (2003), New Zealand Business Benchmarking Survey Financial Statistics 2002, Hamilton: Management Research Centre, Waikato Management School, University of Waikato.Google Scholar
Management Research Centre (2006), New Zealand Business Benchmarking Survey Financial Statistics 2003, Hamilton: Management Research Centre, Waikato Management School, University of Waikato.Google Scholar
Ministry of Health (2000a), The Future Shape of Primary Health Care, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2000b), Summary of Responses to ‘The Future Shape of Primary Health Care: A Discussion Document’, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2004a), General Practitioner Fees Information: A Summary of Key Findings from Five Reports, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2004b), The Health and Independence Report 2004, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2004c), Media Release: Research Confirms Doctor’s Visits More Affordable for Two Million New Zealanders, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2004d), A Portrait of Health: Key Results of the 2002/03 New Zealand Health Survey, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2007a), Very Low Cost Access Payments. http://www.moh.govt.nz/moh.nsf/indexmh/phcs-funding-lowcostGoogle Scholar
Ministry of Health (2007b), Zero Fees for Under Sixes. http://www.moh.govt.nz/moh.nsf/indexmh/phcs-funding-lowcost-under6sGoogle Scholar
Ministry of Health (2008a), Health and Independence Report, Wellington: Ministry of Health.Google Scholar
Ministry of Health (2008b), Health Expenditure Trends in New Zealand 1990–2006, Wellington: Ministry of Health.Google Scholar
Ministry of Health and Ministry of Pacific Island Affairs (2004), Tupu Ola Moui: Pacific Health Chart Book 2004, Wellington: Ministry of Health.Google Scholar
National Advisory Committee on Health and Disability (2000), Improving Health for New Zealanders by Investing in Primary Health Care, Wellington: National Advisory Committee on Health and Disability.Google Scholar
Newhouse, J. P. (1993), Free for All?, Cambridge, MA: Harvard University Press.Google Scholar
Pauly, M. (2007), The Truth about Moral Hazard and Adverse Selection, Syracuse: Center for Policy Research, Maxwell School of Citizenship and Public Affairs, Syracuse University.CrossRefGoogle Scholar
Perera, R., McDonald, J., Cumming, J.Goodhead, A. (2003), Primary Health Organisations: The First Year (July 2002–June 2003) from the PHO Perspective, Wellington: Health Services Research Centre, School of Government, Victoria University of Wellington.Google Scholar
Pōmare, E., Keefe-Ormsby, V., Ormbsy, C., Pearce, N., Reid, P., Robson, B.Watene-Haydon, N. (1995), Hauora: A Study of the Years 1970–1991, Wellington: Eru Pomare Māori Health Research Centre.Google Scholar
Raymont, A. (2004), Cost Barriers to Health Care: Provisional Analysis from the New Zealand Health Survey 2002/03, Wellington: Ministry of Health.Google Scholar
Raymont, A.Cumming, J. (2009), Status and Activities of General Medical Practices, Wellington: Health Services Research Centre.Google Scholar
Rice, T.Morrison, K. R. (1994), ‘Patient cost sharing for medical services: a review of the literature and implications for health care reforms’, Medical Care Review, 51(3): 235–287.CrossRefGoogle Scholar
Robinson, J. (2001), ‘Theory and practice in the design of physician payment incentives’, The Milbank Quarterly, 79(2): 149–177.CrossRefGoogle ScholarPubMed
Roos, N. P., Forget, E., Walld, R.MacWilliam, L. (2004), ‘Does universal comprehensive insurance coverage encourage unnecessary use? Evidence from Manitoba says “no” ’, Canadian Medical Association Journal, 170: 209–214.Google Scholar
Ryall, H. T. (2007), Better, Sooner, More Convenient: Health Discussion Paper, Wellington: National Party of New Zealand.Google Scholar
Ryall, T. (2008), Speech Notes from Address to DHB Chairs in Wellington, DHB Chairs, Wellington.Google Scholar
Schoen, C., Davis, K., DesRoches, C. M., Donelan, K.Blendon, R. J. (2000), ‘Health insurance markets and income inequality: findings from an international health policy survey’, Health Policy, 51: 67–85.CrossRefGoogle ScholarPubMed
Schoen, C.Doty, M. M. (2004), ‘Inequities in access to medical care in five countries: findings from the 2001 Commonwealth Fund International Health Policy Survey’, Health Policy, 67: 309–322.CrossRefGoogle ScholarPubMed
Smith, J.Cumming, J. (2009), Taking the Temperature of Primary Health Organisations, Wellington: Health Services Research Centre.Google Scholar
Starfield, B., Shi, L.Macinko, J. (2005), ‘Contribtuion of primary care to health systems and health’, The Milbank Quarterly, 83(3): 457–502.CrossRefGoogle Scholar
Treasury, T. (2009), Monthly Economic Indicators: January 2009, Wellington: The Treasury.Google Scholar
Tukuitonga, C. (1999), Primary Healthcare for Pacific People in New Zealand, Wellington: National Advisory Committee on Health and Disability.Google Scholar
World Health Organization (2008), Primary Health Care: Now More Than Ever: The World Health Report 2008, Geneva: World Health Organization.Google Scholar