Search

Introduction The 2001 Primary Health Care Strategy provided significant new government funding for primary care (general practice and related services) via capitation funding formulas. However, there remain important unanswered questions about how capitation funding formulas should be redesigned to ensure equitable and sustainable service provision to all population groups. Aim To compare levels of chronic illness, utilisation, and unmet need in patients categorised as ‘high-need’ with those categorised as non-‘high-need’ using the definitions that are used in the current funding context, in order to inform primary care funding formula design. Methods Respondents of the New Zealand Health Survey (2018–19) were categorised into ‘high-need’ and non-‘high-need’, as defined in current funding formulas. We analysed: (i) presence, and number, of chronic diseases; (ii) self-reported primary care utilisation (previous 12 months); and (iii) self-reported unmet need for primary care (previous 12 months). Analyses used integrated survey weights to account for survey design. Results In total, 29% of respondents were ‘high-need’, of whom 50.2% reported one or more chronic conditions (vs 47.8% of non-‘high-need’ respondents). ‘High-need’ respondents were more likely than non-‘high-need’ respondents to: report three or more chronic conditions (14.4% vs 13.7%); visit a general practitioner more often (seven or more visits per year: 9.9% vs 6.6%); and report barriers to care. Discussion There is an urgent need for further quantification of the funding requirements of general practices serving high proportions of ‘high-need’ patients in order to ensure their viability, sustainability and the provision of quality of care.

Poverty, often defined as a lack of resources to achieve a living standard that is deemed acceptable by society, may be assessed using level of income or a measure of individual deprivation. However, the relationship between low income and deprivation is complex—for example, not everyone who has low income is deprived (and vice versa). In addition, longitudinal studies show only a small relationship between short-term changes in income and health but an alternative measure of poverty, such as deprivation, may have a stronger association with health over time. We aim to compare low income and individual deprivation as predictors of self-rated health (SRH), using longitudinal survey data, to test the hypothesis that different measures of poverty may have different associations with health.We used three waves from the longitudinal Survey of Family, Income and Employment and fixed-effect linear regression models to compare low income (<50% median income at each wave) and deprivation (reporting three or more items from the New Zealand individual deprivation index) as predictors of SRH (coded 1–5; SD 1.1–1.2). We also compared the impact of duration of low income and deprivation on SRH using mixed linear models.In the fixed-effect models, moving into deprivation between waves was associated with a larger decline in SRH compared to moving into low income, which persisted in models including both low income and deprivation. Similar findings were observed for duration of low income and deprivation in mixed models.Moving into high levels of individual deprivation is a stronger predictor of changes in SRH than moving into low income. When investigating the association of hardship poverty with health, using alternative measures, in addition to income, is advisable.

Parliamentary Accountability: A Study of Parliament and Executive Agencies edited by Philip Giddings. Basingstoke: Macmillan, 1995. Pp.xi + 260, £35. ISBN 0 333 63201 X.Who Makes Public Policy? The Struggle for Control between Congress and the Executive edited by Robert S. Gilmour and Alexis A. Halley. Chatham NJ: Chatham House Publishers, 1994. Pp.x + 390. £17.99 (paperback). ISBN 1-56643-004-6.Can Responsible Government Survive in Australia? by David Hamer. Canberra: University of Canberra Press, 1994. Pp.viii + 215. $24.95 (paperback). ISBN 085 889 5238.Judicious Choices: The New Politics of Supreme Court Confirmations by Mark Silverstein. New York, NY: W. W. Norton & Co., 1995. Pp.x + 188. £17.50 (paperback). ISBN 0 393 03692 8.Britain's Emerging Euro-Elite? The British in the Directly-Elected European Parliament 1979-1992 by Martin Westlake. Aldershot: Dartmouth, 1994. Pp.319. £35. ISBN 1 85521 529 2.

In New Zealand, existing area-based indices of deprivation were inadequate because of lack of theoretical underpinning and use of comparatively large areas resulting in masking of variation within them. There is growing demand for small area based indices of deprivation for the purposes of resource allocation, research, and community advocacy. This paper describes a new Census-based index of deprivation based on the smallest possible geographical areas using existing Census boundaries. The index uses deprivation variables selected according to established theory, and derived from the 1991 New Zealand Census. Ten age and gender standardised variables were combined using principal components analysis. Each variable is a standardised proportion of people in a small area with a lack of a defined material or social resource. Age/gender standardisation is important to avoid confounding and to improve the performance of indices in resource allocation formulae. The index correlates highly with mortality, hospital discharges, lung cancer registrations and childhood immunisation status.

In New Zealand, existing area‐based indices of deprivation were inadequate because of lack of theoretical underpinning and use of comparatively large areas resulting in masking of variation within them. There is growing demand for small area based indices of deprivation for the purposes of resource allocation, research, and community advocacy. This paper describes a new Census‐based index of deprivation based on the smallest possible geographical areas using existing Census boundaries. The index uses deprivation variables selected according to established theory, and derived from the 1991 New Zealand Census. Ten age and gender standardised variables were combined using principal components analysis. Each variable is a standardised proportion of people in a small area with a lack of a defined material or social resource. Age/gender standardisation is important to avoid confounding and to improve the performance of indices in resource allocation formulae. The index correlates highly with mortality, hospital discharges, lung cancer registrations and childhood immunisation status.

OBJECTIVE:s To compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States. Design Comparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit. Setting Primary care practice. Participants 79 790 office visits in Australia, 10 064 in New Zealand, and 25 838 in the US. MAIN OUTCOME MEASURES: Diagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country. RESULTS: In each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 52 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries. CONCLUSIONS: Despite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.

Examines the significance of the Treaty of Waitangi for health services in New Zealand. Factors to consider in the debate on the implications of race for health; Approach that health care should take to the Treaty; Foundations supporting the effort to address health Maori-Pakeha inequalities.

Background. Health agencies frequently seek to develop indicators of the quality and performance of work done by clinicians. The validity of such indicators is a subject of debate among clinicians and health managers. Objectives. Our aim was to quantify the effects of chance and small caseload on an indicator of referral behaviour for GPs. Methods. The study used random simulation of GP referral to physiotherapy and variance components analysis of routinely collected accident insurance data. It analysed 129 079 episodes of accident-related back pain in New Zealand which were managed by 2679 GPs. The main outcome measure was the percentage of back pain cases referred for physiotherapy and for specialist assessment and by each GP. Results. The observed number of GPs who refer to physiotherapy at high levels is satisfactorily accounted for by chance. The variability of practice among GPs within any one area is not related to the absolute level of referral. Conclusion. The primary care setting, in which a low caseload for any one condition is the norm, presents challenges for measuring clinical performance. An emphasis upon changing the behaviour of GPs with extremely high levels on a performance indicator cannot necessarily be expected to have an impact upon the level of the indicator across a geographic area. Indicators for quality improvement should be used across whole populations of practitioners, rather than used to focus upon extremely high referring individuals.