TRENDS IN PRIMARY MEDICAL-CARE RELATED SERVICES AND EXPENDITURE IN NEW-ZEALAND 1983-93

Aims. To analyse recent trends in primary medical care (PMC) related e xpenditure, general medical services (GMS), pharmaceuticals, laborator y, Accident Compensation Corporation (ACC) and other categories, as a basis for general practitioners, other primary health care providers a nd regional health authorities becoming better positioned to make more effective decisions about the use of this expenditure. Methods. Data from the Department of Health, Accident Compensation Corporation and o ther sources of this expenditure over the period 1983-93 were obtained and analysed. Results. Primary medical care related expenditure betwe en 1982-3 and 1990-1 increased annually at an inflation adjusted rate of 6.1% to a total of $1006.2M. In 1991-2 there was a slight inflation adjusted decrease in overall primary medical care related expenditure of 0.5% although maternity benefits increased by 20.7%. An overall in crease of 2.7% occurred in 1992-3 with a 10.1% increase in laboratory benefits and 16.4% in maternity benefits. Price, volume, mix and other factors were analysed to explain these increases. The overriding dete rminants of the cost increases are the volume of primary medical care related services such as pharmaceuticals, laboratory and maternity ser vices and the mix effect ie, more expensive drugs, tests, etc. Conclus ion. Alternative strategies for control of primary medical care relate d service utilisation costs are discussed. It is suggested that the mo st effective strategy is some form of general practitioner or communit y based budget holding within which general practitioners and/or commu nities are empowered to make decisions about their priorities in achie ving the best possible quality and quantity of primary health care.