Abstract:
Objectives In 2011 an initiative was implemented in Auckland to improve access to after-hours care, by subsidising the cost of medical visits for children aged under six at participating Accident & Medical clinics (A&Ms). The Minister of Health subsequently issued a national directive of similar nature. Some general practitioners (GPs) fear unintended consequences from this policy will result in reduced general practice funding (through funding ‘clawback’) and reduced continuity of within-hours care. This thesis investigated the consequences of the Auckland under-sixes subsidy on access to, and provision of, primary care services in the region. Methods This research took a mixed methods approach, using five studies to investigate the consequences of the subsidy. Changes to after-hours utilisation of subsidised A&Ms, GP consults within-hours, and funding clawback at selected practices were compared between 2010 and 2012, the years immediately prior to and following the subsidy’s implementation. Interviews with a small number of Auckland GPs were carried out. Selected questions from a survey with parents of children using A&M services were also considered. Lessons Learned There has been increased utilisation of subsidised A&Ms after-hours, indicating improved affordability and access. This has resulted in an increase in clawback of funding. However, this was mitigated by a reduction in other forms of clawback, due to a concurrent policy reducing the cost of within-hours care. There was no negative effect on continuity of care, due to parents using A&Ms for urgent rather than routine care. Significantly, this thesis identified a number of methods used by GPs to avoid the perceived threat of clawback, such as disenrolling young patients. Implications The subsidy aimed to increase access to after-hours care in Auckland for young children. However, when combined with other national primary care funding policies, the subsidy has resulted in a system that dilutes the aim of the Primary Health Care Strategy (2001), and reduces access to primary care for young children and possibly other patients. These consequences may also occur as a result of the national directive, and will continue until the poor complementarity of primary care funding policies in New Zealand is addressed.