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This Atlas domain uses information reported by patients about their experience with health services, and builds on what we already know from the national primary care patient experience survey (2018). It reports on responses to seven questions in the 2018 survey to investigate whether there are differences by geographic region and/or patient demographic. These questions were selected as being key for understanding patient’s experience of accessing and using health services.
Access to health care is distinct from utilisation of health care. There is a growing body of evidence describing poorer access among socially disadvantaged groups in New Zealand[2, 3] including our upcoming report A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity (to be published July 2019).
While a different number of people responded to each survey question, on average over 72,000 people answered each of the questions reported here; of these, around 5,600 were Māori, 1,600 Pacific peoples, 4,000 Asian and 61,000 European or other ethnic group.
In this domain, we present unweighted responses and weighted scores. The weighted scores use the population structure who attended primary care in each district health board (ie, those potentially eligible to participate) (age, gender and ethnicity) and compares this with the respondent structure (ie, the age, gender and ethnicity of those who responded to the survey). This creates a co-efficient which is applied to the results of the survey. This then increases or decreases a particular score and provides a weighted result. For further information, including number of responses by age and ethnicity, please view the methodology (350KB, PDF).
Key findings summary
An infographic summarising the key findings is shown below and can be downloaded as a PDF here.
Key findings by question
Note: all the differences between age, gender and ethnicity noted in the text below are statistically significant.
Question: Was there ever a time when you wanted health care from a GP or nurse but you couldn't get it?
One in seven respondents (15 percent) reported a time when they wanted health care from a GP or nurse but couldn't get it.
- This affected women (17 percent) more than men (10 percent).
- There was a clear age gradient, with 22 percent of those aged 15–44 unable to get care compared with less than 10 percent of those aged 65 years and over.
- 24 percent of Māori aged 15–64 years report being unable to get care compared with 18 percent of Asian and Other.
- People reporting a long-term condition were more likely to report being unable to get care than those without a long-term condition, at all ages. For example, of 15–24-year-olds, 30 percent with a long-term condition reported this compared to 19 percent with no long-term condition. The rate was higher for those with self-reported arthritis or long-term pain, asthma or chronic obstructive pulmonary disease (COPD) or a mental health condition.
- This question comes after people have already identified cost as possible barrier. Respondents’ answers often relate to appointment availability, particularly to see their usual doctor at short notice; the wait time for the appointment once they reached the clinic; and clinic hours not being compatible with work hours – a particular issue when patients urgently wanted care.
Question: In the last 12 months was there a time when you did not visit a GP or nurse because of cost?
One in five respondents (20 percent) reported not visiting a GP or nurse because of cost in the last 12 months.
- This increased to 48 percent of those aged 15–24 years with any long-term condition.
- Twenty-three percent of women and 13 percent of men reported not visiting their GP or nurse in the previous year due to cost.
- Younger people reported cost as a barrier to a far greater extent than older people: 37 percent of those aged 15–44 years compared with 10 percent of people aged 65 years and over.
- Age–sex stratified analyses show 43 percent of 15–24-year-old females reported not visiting their GP or nurse at some point in the year due to cost compared with 28 percent of males in the same age group.
Percent of people who report not visiting a GP or nurse due to cost in the last 12 months (2018). Confidence intervals calculated at 95 percent are shown in brackets.
Question: Could you tell us why cost stopped you from seeing a GP or nurse?
Appointment cost was the most common cost barrier.
- Of the 10 percent aged 65 years and over for whom cost was a barrier, appointment cost was the barrier for 87 percent of these respondents. In comparison, appointment cost was a barrier for 71 percent of those aged under 65.
- Twenty-one percent of those aged under 65 years reported the cost of taking time off work prevented them from accessing care. As might be expected, less than 5 percent of those aged 65 and over reported this as an issue.
- Transport cost was a significantly greater barrier for Māori, at 13 percent compared with around 7 percent of Asian and Other ethnic groups.
Question: Has cost stopped you from picking up a prescription?
Nine percent of respondents reported that cost had stopped them from picking up a prescription.
- Women were more affected than men.
- There was a clear age effect, with 23 percent of 15–24-year-olds reporting this barrier compared with 2 percent of those aged 75 years and over.
- At all ages, people who reported a long-term condition were more likely to report not collecting a prescription due to cost, although the difference was most pronounced in those aged under 65 years.
- Young women (15–24 years) were much more likely than young men to report not collecting a prescription due to cost – 24 percent compared with 14 percent.
- People of Māori and Pacific ethnicity reported prescription cost as a barrier more than Asian and Other populations.
Percent of people reporting not picking up a medicine due to cost in the past year by age and ethnicity (2018)
** Rates have been excluded where the count is less than 30.
Question: have you been involved in decisions about your care and treatment as much as you wanted to be?
Overall, 18 percent of people were not as involved in decisions about their care and treatment as they wanted to be.
- Nineteen percent of women and 15 percent of men reported not being as involved in decisions about their care and treatment as they wanted to be.
- While around 2 percent of people were not as involved as they wanted to be, 15 percent of people were only involved as much as they wanted to be to some extent.
- Younger people reported less involvement, with 30 percent of 15–24-year-olds being involved either to some extent or not at all, compared with 13 percent of those aged 65 years and over.
Question: does your GP or nurse spend enough time with you?
Nineteen percent of patients did not agree that their GP or nurse always spent enough time with them.
- Younger people were less likely to report enough time being spent with them, with 31 percent of 15–24-year olds answering ‘yes, sometimes’ or ‘no’ compared with 14 percent of those aged 65 years and over.
- There were limited differences by ethnicity.
- People with a long-term condition typically reported less involvement in decisions and sufficient time being spent with them, but the difference was generally around one to two percent lower and was not as marked as the barriers to access.
Question: You said you did not always follow the instructions when you took the medication. Please tell us why.
Eight percent of respondents said they did not always follow the instructions when they took medication.
- This question highlights that patients are not always sufficiently informed and engaged to take medicines as prescribed.
- This ranged from 10 percent of 15–24-year-olds to 2 percent of those aged 65 years and over.
- When asked the reason why, 58 percent of people said they forgot and 21 percent said they experienced side effects. Younger people were more likely to report forgetting while older people were more likely to report experiencing side effects.
Health service use and the primary care patient experience survey: Key questions to answer as a provider
District health boards, primary health organisations and general practices all have access to the primary care patient experience survey reporting portal (496KB, PDF), which reports their patients’ responses to the survey.
We invite providers to answer the following questions:
- Does your organisation actively track your patients’ responses to the survey questions?
- Do you know which of your patient groups are experiencing the most barriers?
- Do you have a plan to address these barriers?
Below are questions for providers prompted by the findings in this domain, with an indication of whether the questions should be asked at a national organisation, DHB/PHO or general practice level.
Fifteen percent of people reported unmet need for health care; this increased to 22 percent of those aged 15–44
- How does this finding correlate with studies such as the Piper report which identified people being diagnosed late with cancer in emergency departments?
- Are there models of care that might work better?
- What is the GP FTE per capita by region? What other models of care, such as nurse practitioners or health improvement practitioners, could be used?
- Are there sufficient GPs to serve the population?
- What are the downstream impacts for young people who are also experiencing high housing costs and high education costs? What is the longer-term impact on the future?
DHB/PHO and general practice:
- A quarter of women aged 25–44 years report unmet need. Do you know how many women in this age group there are in your region or practice?
- Who is experiencing unmet need (and why) in your region or practice?
- How can you work with the consumer groups who report the largest unmet need to co-design a better system?
- Do you have a high proportion of young or working-age enrolees? If so, would offering extended hours, telehealth or a patient portal help?
- What alternatives to a physical appointment does your practice offer, for example, a patient portal? How many patients report being able to get a response on the same day to an important question?
- When is your third next available appointment?
- Once patients arrive for their appointment, how long do they wait in the clinic for it to start?
- C Jackson, K Sharples, M Firth et al. The PIPER Project. An Internal Examination of Colorectal Cancer Management in New Zealand. 2015. (downloaded June 2019).
Twenty percent of people reported not visiting a GP or nurse due to cost in the last 12 months; for Māori this was 28 percent
- Have funding changes had the desired effect? For example, have community service card changes reduced unmet need?
- How are DHBs and PHOs working to deliver a model of care that can help people better afford primary care and prescriptions?
- Do your patients know about low-cost access practices and how to find them?
- Do your patients know that a community services card reduces appointment cost? Can you provide information on how to apply for a card at your practice?
- Are there subsidises (national or regional) that your patients might be eligible for? How do you inform your patients about these?
At all ages, people who reported a long-term condition were more likely to report not collecting a prescription due to cost
National, DHB/PHO and general practice:
- What percent of people also can’t access tests that have a cost, for example, x-rays?
- What are the impacts for those who can’t afford their medicine or who delay collecting it?
- What are the impacts on you and your patients when medicines are delayed or not collected?
- Are your patients given information on how to access the prescription subsidy scheme?
Young people are more likely to report not being as involved in decisions about their care as much as they want to be and are less likely to report their GP or nurse spends enough time with them
National and DHB/PHO:
- Are the models of care provided for young people appropriate? What youth services are available in your region, eg, youth one stop shops, and do your patients know how to access these?
- What are the implications of these findings given young people also experience greater barriers to accessing care? Are diagnoses and treatments properly explained?
- How do these findings correlate with communication skills?
Younger people were more likely to report forget to take their medicine while older people were more likely to not follow instructions due experiencing side effects
National, DHB/PHO and general practice:
- What support does your population need to enable them to take their medicine as prescribed?
- Have you used the Health Quality & Safety Commission’s health literacy resources?
- Levesque JF, Harris M, Russell G. 2013. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 12: 18.
- Ministry of Health. (nd). Indicator: Excellent, very good or good self-rated health. URL: https://minhealthnz.shinyapps.io/nz-health-survey-2017-18-annual-data-explorer/_w_75e5f2d2/#!/explore-indicators.
- Metcalfe S, Beyene K, Urlich J, et al. 2018. Te Wero tonu—the challenge continues: Māori access to medicines 2006/07–2012/13 update. NZMJ 131(1485).
- Do you know how to log into your reporting portal? Here is the quick guide to the primary care reporting portal (486KB, PDF)
- Let’s plan for better care, 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.