PHOs support strategy – problems with implementation
The community organisations at the vanguard of the Government's strategy to improve New Zealanders health have strongly
backed its Primary Health Care Strategy but criticised its implementation.
That's the view of researchers at Victoria University's Health Services Research Centre, lead by Centre Director Jackie
Cumming.
Ms Cumming said Primary Health Organisations expressed strong support for the philosophy of the Strategy, which involves
greater emphasis on community-based health services working together to reduce the number of people ending up in
expensive hospital-based treatment.
"There is a lot of goodwill present within the sector, and a willingness to 'make it work' to achieve health gains for
everyone. But, despite the support from district health boards, PHO staff reported that the process of establishing the
first PHOs required an enormous investment of time, personnel and resources. They felt that establishment funding was
often inadequate and late and that costs were often masked as much work and time was provided voluntarily and without
reimbursement".
Funding levels for health promotion and management costs were felt to be inadequate and fluctuations in income were also
of concern.
Those interviewed felt a lack of public understanding about PHOs, and about the implications of enrolling with a PHO,
was a major concern.
"Our respondents felt that poor public awareness was felt to be a major hurdle. Most PHOs were also critical about the
lack of information to the public regarding PHOs, and felt that too large a part of the burden of responsibility had
been placed on them with regard to informing the public”.
"PHOs noted that it involved a big educational process for patients, particularly populations that were hard to engage
due to literacy, language and cultural issues. It was felt most patients had little understanding of the structural
issues behind the development of PHOs, and the idea of PHOs was rather meaningless to most people who already felt they
were getting good care or “just want to see the doctor today”.
Ms Cumming said they also found that all Access funded PHOs had reduced payments for patients to see their GPs.
"Opinions varied between PHOs with regard to whether reduced fees had made a difference to access and utilisation rates.
Some were definite that they were seeing an increase in usage, and/or patients accessing services earlier. Others felt
it was too early to say, or that as charges had been low already, patients would not have noticed a big change”.
The research also found that a wide range of new services was being provided or planned under the PHO model.
The report, Primary Health Organisations: The First Year from the PHO Perspective, was released today (Tuesday December
2). The research, which involved interviews and questionnaires with key PHO personnel in 21 of the 34 PHOs that had been
established by April 2003, was carried out under contract to the Ministry of Health to follow the establishment of PHOs.
The research was a precursor to a larger evaluation on the implementation and intermediate outcomes of the Strategy,
which the Health Services Research Centre will be leading and which is funded by the Health Research Council, the
Ministry of Health and ACC. The issues raised in this precursor study will be followed up with a wider range of PHOs
over the next few months.
For more information, contact Jackie Cumming on 04 463 6567 or 021 179 8315.
Copies of the Report are available in the Publications Section, New Reports, from http://www.vuw.ac.nz/hsrc