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New data shows cost as the main barrier to accessing health services

Health Quality Intelligence
26 July 2019

New data from over 72,000 patients who responded to a survey about their experiences with New Zealand health services shows one in five reported not visiting a GP or nurse due to cost in the last 12 months.

The data is part of the new Atlas of Healthcare Variation on health service access released by the Health Quality & Safety Commission. It aims to understand patients’ experience of accessing and using health services and investigate whether there are differences by location and/or patient demography.

Marj Allan, a consumer representative on the Patient Experience of Care governance group, sees the data as being critical to GPs’ understanding of the patients’ needs and how to improve services.

‘Primary care can be challenging because many general practices are their own businesses, and the buy-in has to come from the GPs - they have to see the value they can get out of the data which reflects the consumer voice,’ she says.

Marama Parore, member of the Commission’s Te Rōpu (Māori advisory group) says there is a growing body of evidence describing poorer access to health services for Māori.

Appointment cost was the most common barrier to accessing health services. Overall, one in five people reported not visiting a GP or nurse due to cost in the last 12 months. This increased to 37 percent for respondents aged 15 - 44 years.

‘Young people are more likely to report financial barriers to accessing health care than older people. This may impact on their health over the course of their life,’ she says.

Respondents who also reported having a long-term condition were more likely to report being unable to get care than those without a long-term condition.

‘Of those aged 15-24 years with any long-term condition, 48 percent responded that cost was a barrier for them.

‘Prescription cost is also a barrier, especially for Māori and Pacific peoples,’ she says.

One in five Māori and Pacific peoples reported not collecting a medicine due to cost in the past year. At all ages, people who reported a long-term condition were more likely to report not collecting a prescription due to cost.

‘This highlights a group of patients who have paid for their appointment but cannot afford to get the medicine prescribed to them. Are patients given information on how to access the prescription subsidy scheme?’ asks Ms Parore.

Dr Api Talemaitoga, a member of the expert advisory group who developed this Atlas, says it is clear patients are not as involved in decisions about their care and treatment as they would like to be.

‘Thirty percent of 15-24-year-olds reported that they were involved in their care to some extent or not at all,’ he says.

District health boards, primary health organisations and general practices are being encouraged to actively track their patients’ responses to the survey questions.

‘We invite providers to consider questions such as which of your patient groups are experiencing the most barriers; and do you have a plan to address these barriers?’ says Dr Talemaitoga.

The Atlas for health service access can be viewed here.


  • Let’s plan for your next health care visit, a health literacy initiative to help consumers prepare well for their visit to the GP or other primary care health professional. It encourages people to plan ahead for practice visits and to ask questions when there, so they fully understand their diagnosis and treatment. It also suggests questions they can ask pharmacy staff when they pick up their medicine. This resource is also available in Chinese, Hindi, Māori and Samoan.
  • Three steps to better health literacy: a guide for health care professionals
  • Communicating so people will understand, a poster for health professionals, which provides simple techniques for talking with people about their health or medicines.
  • Medication ‘one-steps’. These resources are intended to:
    • check some aspect of the safety system for a high-risk medicine in any area of work, whether on a ward, across a whole hospital or other care setting
    • stimulate discussion about the system and what changes could be made to reduce the risk of harm from those medicines.
  • Communication strategies at GP level from IHI. 
  • Choosing Wisely has resources for patients and practitioners to help with decisions relating to medicines, such as understanding what happens if people don’t take the medicine.