INEQUITIES IN ACCESS TO AND UTILIZATION OF PRIMARY MEDICAL-CARE SERVICES FOR MAORI AND LOW-INCOME NEW-ZEALANDERS

Aim. To determine the rates of utilisation and expenditure on primary medical care and related services for Maori and low income New Zealand ers and to compare these rates with the average for New Zealand. Metho ds. Data for the 1994/95 financial year were obtained from Health Bene fits Ltd (HBL) for GMS payments in community service card (CSC) catego ries, laboratory and pharmaceutical expenditure and utilisation of gen eral practitioner related ACC services from ACC. Data were also obtain ed from various sources to fill gaps including actual general practiti oner related expenditure. Eight health centres serving predominately M aori but also low income groups totalling nearly 50 000 people provide d data on their practice registers, GMS type utilisation and expenditu re on laboratory and pharmaceutical services. These data were age and CSC adjusted by GMS category to permit valid comparisons with the nati onal data. Results. There were an estimated 15.77 million general prac titioner consultations in 1994/5, a rate of 4.46 consultations per cap ita. Expenditure per capita on GMS, ACC, laboratory and pharmaceutical services was estimated to be $63.07 per consultation and $281.27 per capita. By comparison the rates of utilisation in all the centres stud ied were substantially lower than these national figures both overall and in all CSC groups. Adjusting for age and CSC status total expendit ure on primary medical care and related services for these centres was only about 40% of the national average. Total average income per cons ultation, including GMS, ACC and patient fees, ranged from $16.52 to $ 21.71 a level which, especially for patients with often complicated he alth problems needing prolonged consultations, was unsustainably low. Conclusion. This study confirms gross underutilisation of and expendit ure on primary medical care and related services to Maori and other Ne w Zealanders in poor circumstances. It also confirms what has been kno wn by general practitioners for a long time, that they are required to subsidise many Maori and poorer patients who face financial and other barriers in accessing their services. Practices servicing poorer popu lations cannot subsidise these patients from their fewer better off pa tients. The small advantage of the CSC is largely offset by the reduce d subsidy from ACC. Poor access to and utilisation of primary care ser vices is likely to be a significant factor in the high use of hospital inpatients services by the groups studied. A radical review is requir ed of the current problems of financial access if health services are to have a better chance of improving the health status of disadvantage d New Zealanders.