1980s reforms 'hit primary care'

By MARTIN JOHNSTON

The number of people admitted to hospital with conditions that could have been avoided by adequate GP care rose sharply during a period of radical restructuring and welfare cuts.

Researchers who reveal the trend in today's New Zealand Medical Journal attribute it to a weakening of access to primary healthcare between 1980 and 1997, caused by rising costs and poverty.

The Labour-led Government views the findings as a vindication of its spend-up on GP subsidies and related primary healthcare schemes.

The Waikato University-led study found the rate of "avoidable" hospital admissions was 73 for every 10,000 people in 1980-82. This rose by almost one-third to 96 in 1995-97.

"The increase in avoidable hospitalisation between 1980 and 1997 coincided with the major health reforms, economic restructuring, and welfare reforms of the 1980s and early 1990s," write demographer Professor Ian Pool and colleagues.

They define avoidable admissions as those resulting from 33 medical conditions - including whooping cough, asthma and pneumonia - that can be prevented, monitored and managed by effective primary care.

Pneumonia, responsible for the second highest number of avoidable admissions, rose from 140 for every 100,000 people to 252. Asthma at first rose during the study period, from 287, but then subsided to 256.

Ten per cent of all hospital admissions were deemed avoidable at the end of the study period, up from 7.1 per cent at the start. Greater levels of poverty were associated with a higher rate of avoidable admissions.

While the rate of avoidable admissions rose overall, it declined during the study period's middle years. The researchers attribute this partly to some area health boards, as they were known, boosting subsidies for GPs' patients.

But they say the rise in avoidable admissions subsequently was likely to be associated with the radical health reforms implemented by National in 1993, which were intended to encourage competition and market behaviour in the sector.

" ... it has been argued that the reforms were likely to have had the deleterious effect of severely limiting access to primary care.

"This was not only due to the increases in fees for general practitioner services but also due to welfare cuts which affected the ability to access health services."

This was the case at least until the end of 1996, when the 1993 reforms were modified. The Community Services Card was introduced to reduce the cost of healthcare for poor people, but disadvantaged groups were still likely to under-use primary care.

Health Minister Annette King's spokesman said yesterday the Government was spending an extra $1.7 billion on primary healthcare from 2002 to 2008 - a previously unheard of level of investment - to reduce patients' costs.