Inequities in access to and utilisation of primary medical care services for Maori and low income New Zealanders

Abstract

Aim: To determine the rates of utilisation and expenditure on primary medical care and related services for Maori and low income New Zealanders and to compare these rates with the average for New Zealand.

Methods: Data for the 1994/95 financial year were obtained from Health Benefits Ltd (HBL) for GMS payments in community service card (CSC) categories, laboratory and pharmaceutical expenditure and utilisation of general practitioner related ACC services from ACC. Data were also obtained from various sources to fill gaps including actual general practitioner related expenditure. Eight health centres serving predominately Maori but also low income groups totalling nearly 50,000 people provided data on their practice registers, GMS type utilisation and expenditure on laboratory and pharmaceutical services. These data were age and CSC adjusted by GMS category to permit valid comparisons with the national data.

Results: There were an estimated 15.77 million general practitioner consultations in 1994/5, a rate of 4.46 consultations per capita. Expenditure per capita on GMS, ACC, laboratory and pharmaceutical services was estimated to be $63.07 per consultation and $281.27 per capita. By comparison the rates of utilisation in all the centres studied were substantially lower than these national figures both overall and in all CSC groups. Adjusting for age and CSC status total expenditure on primary medical care and related services for these centres was only about 40% of the national average. Total average income per consultation, including GMS, ACC and patient fees, ranged from $16.52 to $21.71 a level which, especially for patients with often complicated health problems needing prolonged consultations, was unsustainably low.

Conclusion: This study confirms gross underutilisation of and expenditure on primary medical care and related services to Maori and other New Zealanders in poor circumstances. It also confirms what has been known by general practitioners for a long time, that they are required to subsidise many Maori and poorer patients who face financial and other barriers in accessing their services. Practices servicing poorer populations cannot subsidise these patients from their fewer better off patients. The small advantage of the CSC is largely offset by the reduced subsidy from ACC. Poor access to and utilisation of primary care services is likely to be a significant factor in the high use of hospital inpatients services by the groups studied. A radical review is required of the current problems of financial access if health services are to have a better chance of improving the health status of disadvantaged New Zealanders.