Interim report: Primary Health Strategy achieving

27 September 2007

Interim report finds Primary Health Care Strategy achieving its objectives

The Ministry of Health describes the interim report on the evaluation of the Primary Health Care Strategy as a useful reflection of the preliminary phase of implementing the strategy.

The report shows greater use of GP services including those groups who infrequently visited primary health care services.

"Even though it's early days, the most satisfying early result is seeing improvements in reducing inequalities in health and increasing patient utilisation of general practice services - the two key goals of the Primary Health Care Strategy", Deputy Director General, Sector Capability and Innovation Directorate Margie Apa said.

The interim report Evaluation of the Primary Health Care Strategy: Practice Data Analysis 2001-2005 covers general trends consultation rates (use of services) and fees for general practice services delivered by doctors and nurses in the first three years of the Primary Health Care Strategy.

New Zealanders are making more use of their primary health care services. Consultation rates have increased for almost all age groups (up 25 per cent for some) and ethnicities, since the implementation of the Primary Health Care Strategy. Increased involvement of nurses in delivery of primary health care services is also evident in the report.

In addition the Ministry is pleased to note that since the implementation of the Primary Health Care Strategy, 82 Primary Health Organisations have been established, covering 95 percent of the population or around 4 million New Zealanders.

The report focuses on the changes occurring as a result of specific allocations of new funding between June 2001 and December 2005 and covers data representing the first three years of the Government's seven year investment in Primary Health Care.

The Government is investing $2.2 billion in funding over seven years to support the implementation of the Primary Health Care Strategy. This report covers services funded by less than $200 million of that investment. Some big ticket items like pharmaceuticals - now only $3 per prescription item; Care Plus - reduced cost of care for people with high health needs; and Services to Improve Access to primary care are not included in the evaluation.

Over recent years the Government has expected that this additional investment would be reflected in lower fees for patients, however at the time of this report it was acknowledged that some of this additional funding would be retained by practices to maintain the sustainability of the services.

This report asks, have we got the balance right? The answer is 'probably', but we can and are doing better. We have significantly invested in primary health care's ability to provide a sustainable service. Most people would agree that there is no point in having successfully obtained significantly lower fees if we don't have any doctors or nurses to provide the services.

This is an interim report with a further report due in late 2008.

ENDS

Victoria University Health Services Research Centre report: http://www.victoria.ac.nz/hsrc/reports/downloads/PHCSE%20FINAL.pdf

BACKGROUND

Questions and Answers

Why is it important to improve access to primary health care?
The health sector is facing a number of challenges (ageing population, increasing burden of chronic conditions such as diabetes, heart disease and depression, health inequalities) and providing better access to good quality primary health care is critical to tackling these challenges. A strong primary health care system is central to improving the health of New Zealanders.

What difference can primary health care make?
Primary health care is the frontline, so to speak, of health care. A fit for purpose primary health sector, in terms of the challenges outlined above, is critical to tackling these challenges. International research shows that where primary health care is affordable, or free, better health outcomes are achieved. Reducing cost barriers to primary health care is an important component of our ability to tackle the challenges we are facing.

How big is the increase in people using primary health care?
New Zealanders are making more use of their primary health care services and consultation rates have increased for almost all age groups (up 25 per cent for some) and all ethnicities, since the implementation of the Primary Health Care Strategy. .

Why is it important to have more people using primary health care?
Without the Government's investment in primary health care people would be paying far higher fees for visits to their health practitioners and we would likely face a significant shortage of GPs throughout the country. Higher fees combined with a shortage of GPs would reduce visits to primary health practitioners leading to worsening health outcomes and rising health inequalities.

Why does the report concentrate so much on GP fees?
Reducing fees is one of the mechanisms to achieve the goals of the Primary Health Care Strategy by improving access to primary health services. The overall goal is to improve the health of all New Zealanders, with a particular focus on those population groups who experience poorer health.

The fees environment in 2007 is substantially different to the one in place at the time of the study. The process DHBs have used to ensure the increased funding does deliver lower fees has improved with each funding roll out. In addition there is now an independent process in place to ensure lower fees are maintained and that the value of the taxpayers' investment isn't eroded over time.

Without the Government's investment, fees would have gone up more. Other research undertaken by Dr Cumming, using the two most recent New Zealand Health Surveys, suggests that fees might have risen up to 18.1% over three years (5.7% a year, compounded).

Why haven't GP fees dropped as much as expected?
The report attempts to answer the question: 'has the standard consultation fee reduced by the expected amount?' but is only able to give a very qualified 'maybe'. It is difficult to answer this question because of the diverse way that patient fees can be generated - around one in five consultations in Interim PHO practices is discounted and some consultations are significantly shorter so don't attract a normal fee.

Trying to measure the expected reduction in cost of a standard consultation (one service) by looking at reductions in costs across all of the contacts that people make with their regular practice (for a number of different services) is difficult. As the report states:

'if scheduled fees did fall by the amounts required by the Government, our findings reflect likely considerable differences between scheduled and actual fees charged to patients.' (p xiii).

And:

'However, our data reports on actual fees charged to patients as opposed to schedule fees and as a result we cannot comment exactly on the extent to which the Government’s policy aims for those aged 65 years and over have been met, other than to note that the fees charged have fallen by a considerable amount and that the falls may well be reasonable given the likely level of discounting or low fees charged shown by our data.' (p xvi).

This report's analysis of fees tells us only part of the story. The report is complex and our ability to understand its findings is complicated by the fact that the methodology the evaluators have used is different to the approach used by DHBs to monitor patient fees. This restricts our ability to easily compare the results with the fees that have been notified to DHBs.

We know that without the Government's investment, fees would have gone up more, but by how much we don't know. However other research undertaken by Dr Cumming using the two most recent New Zealand Health Surveys suggests that fees might have risen up to 18.3% over three years (5.7% a year, compounded).

Will the lower fees be maintained?
There is now an independent process in place to ensure that the value of the taxpayer’s investment isn't eroded over time. There have been more rigorous processes in place for the roll outs of additional funding since 2005 that will help to ensure the increased funding translates into lower fees for patients.

Information about fees is also more readily available. Patients and health consumers can now easily find out the fees charged in their local community.

Have Nurse Consultation Rates Risen?
It's difficult to be definitive about this but the authors do state that there is evidence of increased involvement of nurses in the delivery of primary health care services. The information in the report provides a good baseline for measuring this in future. An increase in nurse consultation rates is regarded as useful as it reflects greater flexibility of our workforce and greater teamwork in providing primary care services.

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