Evaluation of Auckland Regional After-Hours Network and the After-Hours Initiative

Abstract

Over the past two decades, access to available and affordable after-hours medical care has emerged as a health policy issue in New Zealand, and in Auckland in particular. In 2011, the Auckland Regional After-Hours Network (ARAHN) - a network of health services funders and providers including District Health Boards (DHBs), Primary Health Organisations (PHOs) and Accident and Medical clinics (A&Ms) - was formed with the objective of addressing the need for coordinated after-hours care in the Auckland region. ARAHN developed the After-Hours Initiative (AHI) which was comprised of the following components: • Subsidised patient co-payments at 11 participating A&M clinics across the Auckland region for 5 categories of patients (under 6s, over 65s, Community Service Card holders, High User Health Card Holders, and residents of high deprivation Census areas) • Opening hours of 8am – 10pm for all 11 participating A&Ms • Subsidised of telephone triage services provided by HomeCare Medical Limited (HML). The AHI was developed to address identified barriers to affordable and accessible after-hours care. Many participants in ARAHN also saw it as a way of addressing the problem of increasing rates of hospital Emergency Department (ED) utilisation. This initiative built on a number of pre-existing services and contractual arrangements. Collectively, DHBs, PHOs and A&Ms contributed $11.8m to fund the three components of the AHI for the 22 month period of 5 September 2011 to 30 June 2013. However, only about $3.2m of this can be considered as new investment into after-hours services. A team of researchers led by the University of Auckland’s School of Population Health were contracted by ARAHN to provide an independent evaluation of the After-Hours Initiative and the progress of the network. The evaluation primarily considers the impact of the additional funding of after-hours services in Auckland. The evaluation team collected data on after-hours service utilisation, carried out a survey of over 500 after-hours patients and conducted 17 key informant interviews.