Does subsidisation of primary care co-payments after-hours address unmet need and reduce the burden on hospital emergency departments? Lessons learned from the evaluation of Auckland’s after-hours initiative

Abstract

Objectives The lack of affordable access to after-hours primary care for many patients has emerged as a pressing health policy problem over the past ten years in New Zealand. In Auckland, an initiative to reduce barriers to access was implemented in late 2011. A key part of this initiative was the subsidisation by Auckland DHBs and PHOs of patient co-payments to some Accident and Medical (A & M) clinics for particular population categories. Methods The evaluation team analysed 40 months of utilisation data (pre and post-initiative) for all hospital EDs and participating A & Ms in the Auckland region; surveyed over 500 patients, and interviewed 17 key informants. Lessons Learned There were significant increases in utilisation of A & Ms for patients aged under 6, in areas where co-payments were reduced to $0. However, no significant increases in A & M utilisation were apparent for other eligibility categories, despite some large decreases in co-payments. Higher than expected A & M utilisation for under 6s was not accompanied by lower than expected ED utilisation. Proximity and familiarity were significant drivers of patient decisions. A general lack of patient awareness of lower co-payments may have contributed to the lack of effectiveness for groups other than under 6s. Implications The proposition that reducing access barriers to after-hours care in the community reduces pressure on hospital EDs needs to be revisited. Lower co-payments may assist in meeting unmet primary care demand, but only if the cost to patients is very low.