āori and Pacific children face more barriers to seeing a GP than other children and those who do are twice as likely to be hospitalised, according to a new report led by a Te Herenga Waka—Victoria University of Wellington researcher.
The Prevalence and Consequences of Barriers to seeing a GP report, funded by the Ministry of Social Development’s Children and Families Research Fund, found 8.3 percent of Māori children and 7 percent of Pacific children experienced barriers to seeing a GP between the ages of 12 and 24 months, compared with 2.8 percent of New Zealand European children.
This rose to 9 percent for Māori children and 9.1 percent for Pacific children between the ages of 42 and 54 months, compared with 3.2 percent for New Zealand European children.
Overall, nearly 5 percent of all New Zealand children experienced barriers to seeing their GP between the ages of 12 and 24 months, rising to 5.5 percent for 42–54 months.
The report was based on analysis of the University of Auckland’s Growing Up in New Zealand data from 5,947 children born in Auckland, Counties Manukau, and Waikato, and is the first longitudinal study in Aotearoa New Zealand looking at inequities in access to care over time.
Lead author Dr Mona Jeffreys, a senior research fellow in Te Hikuwai Rangahau Hauora—Health Services Research Centre in the University’s Te Wāhanga Tātai Hauora—Faculty of Health, is concerned by the higher level of hospitalisations experienced by Māori and Pacific children who faced barriers to accessing a GP.
Māori and Pacific children whose mothers reported a barrier to seeing a GP at age 24 months were more than twice as likely to be admitted to hospital between the ages of 42 and 54 months. This was not the case for New Zealand European children.
Dr Jeffreys says this has major health, social, and cost implications for whānau and the health system. She says being unable to access primary health care contributes to poor health outcomes and ongoing significant health inequities.
“Given it starts at such a young age, if you have a health condition that’s not dealt with, you end up in hospital, that means time off school, and all that has a knock-on effect not just in terms of health but the wider experience of childhood.”
At a broader level, there is the financial impact on the health system of hospital treatment that could have been avoided and is much more costly than primary care, she says.
One reason for the difference in hospitalisation rates could be that Māori and Pacific children who faced barriers to accessing a GP were more likely to experience these on more than one occasion (49.6 percent and 51.7 percent respectively) compared with New Zealand European children (37.8 percent). A similar pattern was seen at age 42–54 months.
Dr Jeffreys says these figures could show that more New Zealand European children were being treated earlier and were thereby able to avoid hospitalisation.
Since the mid-1990s, numerous policies have been introduced to improve children’s access to GPs, such as zero fees for standard consultations for children under age 14 years. However, barriers to access remain and disproportionately affect Māori and Pacific children.
Social determinants of health and racism explain some of the results but not all, says Dr Jeffreys.
The most common barrier reported was not being able to get an appointment, followed by needing after hours care or not having transport. Cost also remained a barrier for some children. It is possible costs were incurred for non-standard visits, children not enrolled at a practice, travel, alternative caregivers for other dependents, and time off work.
“For someone who is paid by the hour, taking time off to take your child to the doctor sometimes is not an option. Things have to be really serious before someone will take time off if they are going to lose wages on top of the cost of getting there,” says Dr Jeffreys.
She says more specific research is needed to examine the exact reasons these barriers remain, alongside policy action to improve access to GPs for Māori and Pacific people. She says non-cost factors, such as the location of primary health care services and the possibility of outreach and/or mobile services, should be considered.
Any changes must align with contemporary interpretations of Te Tiriti o Waitangi to ensure health equity becomes a reality for Māori, says Dr Jeffreys.
Primary health organisations should ensure all children who present for care are enrolled with a practice so they qualify for free GP visits, she says.
Co-authors of the report include Te Herenga Waka—Victoria University of Wellington’s Dr Kirsten Smiler (Te Whānau a Kai, Te Aitanga-a-Māhaki, Rongowhakaata, Te Whakatōhea), Dr Megan Pledger, and Dr Jacqueline Cumming; Dr Lis Ellison Loschmann (Te Āti Awa, Ngāi Tahu, Ngāti Toa Rangatira, Ngāti Raukawa) from Flax Analytics; and Dr Jonathan Kennedy from the University of Otago, Wellington.