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The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

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Updated data shows cost the main barrier to accessing health services

Health Quality Intelligence
19 June 2020

Updated data from over 79,000 patients who responded to a survey about their experiences with Aotearoa New Zealand health services shows 17 percent reported not visiting a GP or nurse due to cost in the last 12 months. This is a 3 percent decrease from 20 percent in 2018.

The data is part of the updated Atlas of Healthcare Variation domain 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.

Dr Rawiri McKree Jansen, a member of the expert advisory group developing this Atlas domain, suggests questions remain about how the health system addresses the unmet need for those who report not visiting a GP or nurse because of cost, especially the high percentage of young people reporting cost as a barrier to care.

‘The 3 percent reduction in people reporting cost as a barrier is pleasing but, in 2019, 37 percent of people aged 15–24 years reported a time in the last year when they didn’t visit a GP or nurse due to cost. What care are they foregoing? What is going untreated?’

Dr Jansen says it is an issue of equity and that the impact is disproportionately borne by Māori and Pacific peoples.

‘Because Māori and Pacific peoples experience disease at a younger age and have a younger population overall, as a group their health is being compromised to a greater extent than that of other ethnic groups.’

Appointment cost was the most common barrier to accessing health services. Of the 8 percent aged 65 years and over for whom cost was a barrier, appointment cost was the barrier for 95 percent. In comparison, appointment cost was a barrier for 89 percent of those aged under 65 years.

Twenty-nine percent of those aged under 65 years reported the cost of taking time off work prevented them from accessing care.

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, 45 percent responded that cost was a barrier for them,’ says Dr Jansen.

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

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. It raises the question of whether patients are being given information on how to access the prescription subsidy scheme.’

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 Jansen.

Helpful resources for patients and clinicians

  • Let’s PLAN for better care, a health literacy resource 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.