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WONCA Asia-Pacific Regional Meeting, <name of location>, <date>

New Zealand. WONCA Asia-Pacific Regional Meeting, <name of location>, <date>. Felicity Goodyear-Smith Department of General Practice & Primary Health Care University of Auckland, New Zealand. Demographics of New Zealand’s population. Population 4.4 million Distribution >80% urban

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WONCA Asia-Pacific Regional Meeting, <name of location>, <date>

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  1. New Zealand WONCA Asia-Pacific Regional Meeting, <name of location>, <date> Felicity Goodyear-Smith Department of General Practice & Primary Health Care University of Auckland, New Zealand

  2. Demographics of New Zealand’s population Population4.4 million Distribution>80% urban Ethnicity68% European, 15% Māori, 9% Asian, 7% Pacific peoples, 1% Other (2006 Census) Unemployment rate 6.2% (Mar 2013) etc

  3. Overall health system design Strong expectation of state funding (social democratic tradition) Public / private mix Public hospitals free, universal access Private insurance available - offers choice of specialist & hospital care eg elective surgery Primary care variably subsidized – GP services mixture of state & out of pocket Medicines & investigations heavily subsidized No fault liability – Accident Compensation Corporation

  4. How primary care is delivered in New Zealand • Primary Health Organisations (PHOs): Multidisciplinary PHC team - GPs, nurses, pharmacists, allied health • Capitated government funding: • Based on numbers & characteristics of enrolled patients • Pays for: • Care & treatment when ill • Help stay healthy • Outreach, reduce inequalities

  5. Access to primary health care in New Zealand Government + fee for service paid by patientFree: Immunisations, Antenatal, 0-5 years consultations, (most), Practice nurse consultations (often), X-ray, Laboratory,Funded projects directed at specific populations (eg Chronic care management, Services to Improve Access)Mixed funding: General consultations (FFS), ACC (may be surcharge), pharmaceuticals: part charges, physiotherapy (may surcharge)

  6. What are the benefits? • Most of population enrolled with GP clinic • Childhood immunisations • Continuity of provider • Screening • Influenza vaccine • Health checks • CVD risk assessments • Chronic disease management • Ministry of Health. 2008. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington

  7. What are the drawbacks? Co-payments – Barrier for someInequity – Extra funding for socially deprived populations not individualsAccess within 24 hours – at least once annually 20% not able to see GP within 24 hours Complexity of funding – Complicated, frequent changesPoor primary–secondary integration – Unable to follow patients in hospital

  8. Impact on patient care Cost barriers – Means some do not access GP, uncollected prescriptionsIn general, family & patient-centred comprehensive careContinuity of careBoth individual & population-based

  9. Impact on patient care Cost barriers – Means some do not access GP, uncollected prescriptionsIn general, family & patient-centred comprehensive careContinuity of careBoth individual & population-based

  10. Growing health care burden in New Zealand

  11. Ability of health system to respond to challenge

  12. Lessons for other countries

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