Holes in the safety net? Assessing the effects of targeted benefits upon the health care utilization of poor New Zealanders

This paper examines the issue of targeting primary health-care benefits in favour of low-income recipients and other high users of health care. Specif ically we examine the New Zealand case where, despite the introduction of s uch benefits in 1992, financial barriers appear to remain a significant det erminant of utilization. We address this issue through a case study conduct ed in the city of Christchurch. Through a survey-based research design, we seek to determine the extent to which price barriers remain important by co mparing patient utilization of a free community health clinic (n = 202) wit h a low-income control sample of patients who continue to use conventional (for New Zealand) fee-for-service providers (n = 148). We found that a larg e proportion of respondents delayed seeking care because of cost. Further,f or respondents using the fee-for-service providers, levels of use were not related to need, whereas at the free clinic there was an inverse relationsh ip between income and consultation rates. We conclude that if a universalit y of benefits is not possible, then there is a need for better targeting of primary care benefits. We believe there is a danger in such. initiatives b eing evaluated primarily in terms of their validity as funding mechanisms, rather than in terms of their success in meeting the health-care needs of t he disdavantaged.