How do we address the enrolment crisis in New Zealand?
General Practitioners in New Zealand are facing considerable challenges, operating under strenuous conditions within a system that suffers from chronic underfunding. This situation has resulted in some GPs having to select patients based on their health status, a clear indicator of systemic failure rather than individual choice. The current state of affairs is further exacerbated by a funding model known as capitation, which has been critically reviewed in 2022 for its inadequacies. The review highlighted the model's failure to adequately fund services. The consequences of these systemic issues are severe. A staggering 79% of New Zealand's GPs have been forced to close their books to new enrolments or limit them, creating a significant barrier to accessing primary healthcare. This limitation on enrolments has led to an increased burden on emergency departments and poses long-term health risks, including the potential for delayed diagnosis and treatment of critical conditions such as cancer, heart attacks, and diabetes.
In response to these challenges, general practice organisations have called for substantial funding increases, rejecting a proposed 5% increase in favour of at least 14%. To address the broader systemic shortcomings, experts suggest a comprehensive reform of health funding mechanisms, drawing upon best practices in behavioural economics to encourage the evolution of efficient healthcare structures and non-governmental healthcare providers.
Proposed reforms include the embedding of performance indices into capitation contracts, co-development of provider outcome measures, publication of performance and outcome measures to empower patient choice, and ensuring that funding for high-needs enrollees is effectively targeted. Furthermore, the introduction of variable-length consultations and a shift away from an accountability-free capitation system are advocated to address the mismatch between funding mechanisms and the actual healthcare needs.
The adoption of value-based primary care models from international examples, such as Kaiser Permanente's drop-in consultations and Massachusetts' algorithm model for managing heart failure and hypertension, presents viable pathways for improving New Zealand's primary healthcare system. These models emphasise the importance of accountability, efficiency, and patient-centered care, offering a blueprint for the transformation required to overcome the current challenges faced by GPs and their patients in New Zealand.