Research shows reductions in healthcare inequities not sustained

Research from Victoria University of Wellington has shown that the early successes of health policy changes designed to reduce inequities in access to primary healthcare were not sustained.

The study analysed data from the Ministry of Health’s New Zealand Health Survey collected before and after policy reforms in the early 2000s that were designed to improve primary healthcare access for New Zealanders. The research was carried out by Master’s student Michael Thomson under the supervision of Professor Jacqueline Cumming, Director of the University’s Health Services Research Centre.

“Early evaluations of these policy changes suggested they were successful at improving access to doctors,” Michael says. “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.”

Policy changes in the early 2000s brought in universal subsidies for general practice services, decreasing the cost of GP visits for all New Zealanders. The initial increase in visits suggests that universal subsidies can be effective in reducing inequities in access, Michael says, but policy-makers need to consider how primary care providers will meet demand for more consultations.

“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.

“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.”

Michael says previous research suggests that policy changes introduced in 2006 could help reduce inequities by making sure high-needs patients have low-cost access no matter where they’re enrolled.

Michael says this work is timely with the government’s Health and Disability System Review underway.

“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.”

The research was published in the international journal Health Policy.