Primary Health Organisations. Sort by: Default Name. List Map. Alliance Health Plus Trust. Auckland PHO. Central PHO. Christchurch PHO. Compass Health. Eastern Bay Primary Health Alliance. Hauraki PHO. Health Hawkes Bay Limited. An important concept for people who belong to a PHO practice is the concept of continuity — the added value that comes from a long-term relationship that people have with their health provider.
Care Plus is a service introduced through Primary Health Organisations PHOs and is aimed at people who need to visit their family GP or Nurse often because of significant chronic illnesses such as diabetes or heart disease, have acute medical or mental health needs, or a terminal illness. If you have a long-term health condition or a terminal illness, you may be eligible for Care Plus. GPs get extra government funding for Care Plus patients, so can provide additional care at no further cost to the patient.
This means they get extra government funding to keep their fees at low levels. Last modified: 20 November This funding pays for: providing care and treatment when people are ill helping people stay healthy reaching out to those groups in their community who have poor health or who are missing out on primary health care. Care Plus Care Plus is a service introduced through Primary Health Organisations PHOs and is aimed at people who need to visit their family GP or Nurse often because of significant chronic illnesses such as diabetes or heart disease, have acute medical or mental health needs, or a terminal illness.
Providers then become responsible for the PHC of the population enrolled, and accountable through contracts. However, when not all the population is enrolled, the system may place some groups at a disadvantage, perpetuating inequities in health. International literature warns of the challenge of existing low and late enrolment coverage together with poor acceptability of services, particularly among specific population groups [ 5 ]. A recent study in Ontario Canada found that enrolment rates in new comprehensive PHC models were consistently lower amongst immigrant groups than long-term residents, making it difficult to achieve equitable access to integrated PHC services for immigrant populations [ 18 ].
Consequently, the authors recommend ensuring enrolment by all population groups, taking into consideration social diversity, inequality and disadvantage to overcome low enrolment challenges by immigrant populations, such as outreach or drawing support from social networks [ 5 ]. In the case of Aotearoa New Zealand, data suggests that not all those eligible are enrolled, and that there are significant differences depending on population characteristics [ 19 ].
By analysing who is not enrolled with PHOs in Aotearoa New Zealand and how this has changed over time, we aim to achieve a better understanding of the equity implications of the enrolment system in PHC. Other countries employing patient registration systems in PHC may benefit from learning from the Aotearoa New Zealand case by drawing lessons that could be applied to improve their own enrolment systems and its monitoring.
Consequently, we investigate the extent and composition of populations enrolled in PHOs, addressing the following questions:. There are twenty DHBs in Aotearoa New Zealand, responsible for providing or funding health services in their geographical districts. Figure 1 shows the map of Aotearoa New Zealand with all 20 DHBs and their enrolled population numbers, depicting the very different sizes of DHBs both in terms of enrolees as well as territory.
We analyse annual data on the proportion of people enrolled in a PHO. The complexity associated with this indicator is that there are two different sources of data for the numerator and denominator. Footnote 4 The launch of a real-time NES system in served to better harmonize national data, although still there may be differences associated with progressive adoption of the NES Footnote 5 and data collection by PHOs.
A person can only be enrolled in one PHO at a time; the system de-enrols patients when they enrol in a different PHO or three years following their last visit [ 23 ]. Each of these factors would affect reported enrolment rates. The denominator is based on population projections from Statistics New Zealand [ 24 ] based on the Census, and provided in November for data, and in November for data. Footnote 6 Although a new Census took place in , delays with analysis and concerns around data quality [ 25 , 26 ] have hindered its use.
We use annual enrolment rate aggregated data for all DHBs by ethnicity, age and deprivation for all available years at the time, —, using fourth quarter data. The current presentation of data precludes analysis of different variables at the same time. There is a likely mismatch in the ethnicity composition, between the prioritized ethnicity from the NES for the numerator, and from census prioritized data for the denominator [ 30 ].
It classifies each small geographical area according to its level of socioeconomic deprivation based on nine variables measured in the census. The resulting scores are ranked, then categorized into quintiles, where quintile 1 represents the least deprived areas and quintile 5 the most deprived ones [ 31 ].
Due to incomplete NZDep data, we adjust enrolment rates, when stratified by deprivation, by reducing the population numbers by an equal proportion across the five deprivation groups. The original and adjusted data are reported. Evolution of percentage of population enrolled in a PHO, per ethnicity group, — Data source: Data compiled from MoH [ 21 ].
The differences across age groups widened over the study period Fig. Evolution of percentage of population enrolled in a PHO, by age group, — The differences between age groups are echoed in the results stratified by DHB.
Data suggests that the differences in enrolment levels across deprivation quintiles have widened over time. A similar pattern was seen when enrolment rates were adjusted to account for missing NZDep data those with no quintile assigned see Fig.
Evolution of percentage of population enrolled in a PHO, per deprivation quintile, — Our results show that a significant proportion of the population is not enrolled in any PHO, and this has slightly worsened since Here we discuss potential explanations behind these trends.
First, data limitations emanate from using registered enrolments in the numerator and population projections in the denominator. Also, there may be people who are enrolled with a PHO but are not currently living in the country i. Enrolment rates in Auckland DHB are particularly susceptible to methodological issues given differences in enrolments when considering different definitions of DHB used in the data: DHB of domicile or lead DHB Footnote 7 : , vs , enrolees respectively in [ 19 ].
Other factors for the low enrolment rates may relate to Auckland having a higher proportion of young people, a growing population through internal migration Footnote 8 and a potential higher proportion of residents not qualifying for New Zealand public funding for health care.
These factors may contribute to underestimation of real enrolment rates. Beyond data and socio-demographic factors, there seem to be issues suggesting worsening in PHC access.
This relates to the recognised decreasing rate of GPs per population, and further shortages of GPs are expected as GPs reach retirement age [ 34 ]. Current and expected future GP shortages are a global issue, also reported in Australia [ 35 , 36 ] and the UK [ 37 ] for example. The issue of closed books would suggest that people are willing but unable to enrol.
Another factor may be the possibility of people not enrolling because of legal or immigration concerns, as these are one of the recognised barriers to accessing care by migrant populations worldwide [ 38 ]. The lower enrolment rates for youth and younger adults may seem reasonable given that people aged 15—24 are generally healthy and have a lower level of need for medical care.
Another explanation is that young people tend to have lower incomes and consultation fees may deter them from visiting a GP, even with the lower fees for those aged 14— The low enrolment rates of young people suggest the need to monitor that their needs are being met.
Worldwide, it is recognised [ 40 ] that adolescents and youth face specific challenges in accessing health services around issues of staff attitudes, age-appropriate environment, etc. In addition, Zeratsion [ 41 ] advocates raising the age threshold for zero PHC fees based on the experience in Norway of increases in PHC use among adolescents following co-payment exemptions, and that late adolescents would have more health needs that younger ones.
We would expect newly born children be enrolled and remain so in their early years given that standard consultations are free for young children, their needs for a greater intensity of visits for follow ups and vaccinations, and because providers can pre-enrol new-borns before their full enrolment process is completed [ 42 ].
This backs up the positive effect of zero fees on enhancing access to health services for children. Moreover, if it is possible to achieve such high rates for those aged 5—14, it may be possible for other age groups also. The deprivation analysis points at the widening gap between deprivation quintiles.
We have identified a data caveat here,, the contradictory trends between specific quintiles and the overall national picture Fig. These may be due to the exclusion from the quintile breakdown of those not having a deprivation level assigned, but who are included in the national rate and population estimations Footnote 10 ; this problem may be more accentuated for year when automatic NES enrolment was fully functional and the proportion of people with missing NZDep scores went from 1.
Our attempt to align enrolments with national figures helps to understand the time trends, though it remains imprecise in itself; missing data is probably not random, so applying it equally to the five groups introduces a bias, just as missing data does.
Further work is required to better understand the relationship between PHO enrolments and deprivation levels. All in all, the fact that enrolment rates are higher for the most deprived deciles than for those in the middle-lower end suggests the positive impact of targeted schemes in enhancing access of the most deprived areas. The results and implications discussed point at the need to consider additional ways to ensure specific groups of people do enrol, such as outreach or drawing support from social networks [ 5 ].
Our findings are consistent with international literature [ 4 , 5 , 18 ] in that PHC enrolment rates serve to identify inequities in health care access. Efforts should be made to reduce methodological flaws of the indicator as recommended in our deprivation analysis and more broadly by Chan et al.
Further analysis could also include understanding how promoting PHO enrolment may enhance continuity of care. Individual-level enrolment data would render more detail and allow to control for the effects of multiple variables. A multi-country comparison of enrolment rates could render a better understanding of for example targets for specific age or deprivation groups. Finally, our understanding of how an enrolment system may serve to promote equity in health care would benefit from considering a wider understanding of equity in health that takes into account acceptability [ 48 ], including the perceptions of potential users around equity and access as recommended by Mooney [ 49 ].
Having as many people as possible enrolled with a PHC provider is instrumental to maximising the full potential of PHC for all, and to enhancing equitable access to services. In Aotearoa New Zealand, not all eligible people are enrolled with a PHO and inequities exist between socio-demographic and geographic groups.
We have discussed potential reasons behind the enrolment gap, both methodological inconsistencies as well as reasons pointing at worsening access to health care and inequities. We need to better understand why people are not enrolling with a PHO and its implications. In particular, reducing disparities across population groups could be used to track equity in health access.
The research deepens our understanding of the enrolment rates and its potential pitfalls specially in relation to equity in the case of Aotearoa New Zealand.
These recommendations apply not only for Aotearoa New Zealand but for all countries using patient enrolment systems. It is important to tease out and monitor over time the extent and composition of the populations not being enrolled and the reasons and implications for health access and outcomes in order to keep track of equity.
These equity concerns need to be considered when adapting PHC enrolment systems and associated funding models across countries. The underlying motivation of this study is that we need good proxies to monitor the performance of PHC services; having the highest possible proportion of the population enrolled is the starting point to examine both performance and equity in a system using patient enrolments.
For countries with this system, having more robust indicators and data around the enrolment gap will provide more precise and evidence-based understanding of the equity challenges in PHC. This in turn will enable prioritizing the redress of inequities in health policy. PHC advocates need to promote improving these indicators and their use as a starting point to monitor and prioritize equity in health care. PHOs are local, non-governmental, not-for- profit organisations, funded by their local District Health Boards to manage primary health services for their enrolled populations [ 8 ].
The ENS is an IT enhanced system that enables real-time patient enrolment status data from all GPs and centralised It allows calculations for capitation funding based on updated enrolled users. This suggests that population projections are updated annually from Statistic New Zealand, though there are no notations for — data to confirm this.
Assuming population projections account for these population movements and with a time lag in enrolling with a GP in a new location. Accessed 2 May Contribution of primary care to health systems and health.
The Milbank Quarterly, Vol.
0コメント