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

2. Demographics of New Zealand’s population Population 4.4 million Distribution >80% urban Ethnicity 68% European, 15% Māori, 9% Asian, 7% Pacific peoples, 1% Other (2006 Census) Unemployment rate 6.2% (Mar 2013) etc

3. 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 Overall health system design

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 patient Free: 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. Co-payments – Barrier for some Inequity – Extra funding for socially deprived populations not individuals Access within 24 hours – at least once annually 20% not able to see GP within 24 hours Complexity of funding – Complicated, frequent changes Poor primary–secondary integration – Unable to follow patients in hospital What are the drawbacks?

8. Cost barriers – Means some do not access GP, uncollected prescriptions In general, family & patient-centred comprehensive care Continuity of care Both individual & population-based Impact on patient care

9. Cost barriers – Means some do not access GP, uncollected prescriptions In general, family & patient-centred comprehensive care Continuity of care Both individual & population-based Impact on patient care

10. Growing health care burden in New Zealand

11. Ability of health system to respond to challenge

12. Lessons for other countries