This was produced on behalf of Health Services Research Centre as HSRC Discussion PaperNo. 7.
New Zealand governments in recent years have required government agencies to promote ‘better and fairer access to services’, including geographic accessibility (Upton 1991; Creech 1999). New Zealand’s current government expects better access to contribute to improving health outcomes and eliminating disparities (King 2000). The Government’s New Zealand Health Strategy (NZHS) guides District Health Boards (DHBs), and one of its seven fundamental principles is ‘timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay’ii (King 2000:vii). Further, the Government expects accessible services to contribute to reducing health status inequalities for target groups (Mâori; Pacific peoples; and, lower socio-economic groups). Yet links between access and health are poorly understood.
Most research on variations in access and how to improve access to care in New Zealand relates to primary care services. This paper reports on research that is a first stage in systematically understanding trends and variations in access to the health care system in New Zealand. Our initial focus is access to secondary care and proximity to health services, drawing together strands of research on utilisation and proximity to health services. This is a starting point to explaining health status variations across regions, and suggesting more efficient distributions of health resources.
This paper reports findings from a pilot study summarising variations in utilisation rates for publicly funded secondary health care services in New Zealand during 1996.iii Economic and geographic approaches are combined to focus on the relationship between distance and access using linked national datasets including the health service-related National Minimum Data Set (NMDS), Census data and a hospital location data set.iv We develop a conceptual framework for access in New Zealand’s health system and demonstrate a method for explaining geographic variations in utilisation. The study tests the simple hypothesis that health care utilisation falls the further a patient lives from the service