Project 1: Macro Level – National picture and policy – trends in primary health care

Project outline

The aim of this project is to give an overview of what we know about access to primary health care in Aotearoa New Zealand. We are analysing enrolments, fees, utilisation, barriers to access and funding of primary health care services. These analyses will give us a broad understanding of what has happened to each of these indicators over the past 20 years, since the Primary Health Care Strategy was implemented in 2001. This sort of evidence allows us to assess where we have come from, in terms of access to primary health care, and allows analysis of recent data to understand what changes are currently happening, and how these may be influencing access.

Equity is central to this project. Our primary focus of equity is for Māori. We also perform analyses of data on Pacific peoples, by age, sex, income level and deprivation. Where possible, we look at multiple levels of these, e.g. access to care among Māori on low incomes. This approach can give an indication of where policies are and are not working for some people.

For further information, contact:
Dr Maite Irurzun Lopez
Dr Mona Jeffreys


Jeffreys M, Senior T, Irurzun Lopez M, Cumming J, Hau K, Crampton P. (2021). Do general practice capitation fees account for concentrations of complexity? Final report to Royal New Zealand College of General Practitioners. Wellington: Health Services Research Centre

Some data on barriers to access to care, analysed as part of this project, is contained in the HQSC Window 2019 publication:

Health Quality and Safety Commission (2019). A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity | He matapihi ki te kounga o ngā manaakitanga ā-hauora o Aotearoa 2019 – he tirohanga ki te ōritenga hauora o te Māori. Wellington, New Zealand.

Jeffreys M, Irurzun Lopez M, Ellison-Loschmann L, Cumming J. (2019) Cost barriers to primary health care for Māori in New Zealand. Oral Presentation at the 11th Health Services and Policy Research Conference, Auckland, 4-6 December).

Irurzun Lopez M, Jeffreys M, Cumming J. (2019) Inequities in access to Primary Health Care in Aotearoa/New Zealand – Lessons from administrative and survey data on being enrolled with a Primary Health Organization and having a usual General Practitioner, 2002-2019. Oral Presentation at the 11th Health Services and Policy Research Conference, Auckland, 4-6 December).

Jeffreys, M., Cost of and cost barriers to primary health care in Aotearoa New Zealand: focus on equity. HSRAANZ Webinar, 29 October 2020: HSRAANZ Webinar Library

Policy briefs

All analyses that we conduct will be summarised in policy briefs, which will be added here as they are prepared.

The team

Maite Irurzun Lopez is a health and development economist, working on financing of primary health care, equity in access to services, and economic evaluation of health promotion interventions. Maite has trained and worked internationally over the last 20 years. Her areas of expertise include the economics of epidemics (HIV/AIDS, meningitis, dengue, Ebola), costing of epidemiological surveillance for vaccine preventable diseases, and sexual and reproductive health programs in low income settings. In Project One, she is working with administrative data on enrolments and access to primary health care as well as with PHO funding data.  Further information on Maite can be found here.

Mona Jeffreys is an epidemiologist, with a specific interest in access to care and health equity. She trained at the London School of Hygiene and Tropical Medicine and the University of Bristol (UK). She has worked on a number of projects that have used national collections of data in Aotearoa New Zealand, and in the current project, she is responsible for the analysis of the New Zealand Health Survey data.

Lis Ellison-Loschmann (Te Atiawa, Ngāi Tahu, Ngāti Toa Rangatira, Ngāti Raukawa) is an epidemiologist, with a specific interest in respiratory illnesses, cancer and access to care for Māori.

Jackie Cumming is an advisor to the research team.  She is a past Director of the Health Services Research Centre.

Pushkar Raj Silwal is a public health professional. Trained in population health at the University of Auckland, Pushkar has worked in international organizations in health system strengthening. He is doing a Ph.D. in health system performance management and policy, and his areas of interest include health system improvement, Big Data, and policy research. In the current project, Pushkar is analysing the New Zealand PHO enrolment dataset, Mortality dataset, and National Minimum Dataset.  

Tessa Senior is research assistant at Te Hikuwai Rangahau Hauora | Health Services Research Centre and a student of Health Psychology at Victoria University.

Previous staff

Abdul Azeez Abdul Wahab is a health economist and visiting fellow at the Health Services Research Centre / Te Hikuwai Rangahau Hauora. He has conducted international comparisons on the effects of public health care expenditure. His current work centres around trends in household expenditure on health based on the New Zealand Household Expenditure Survey.

Ali Leota is a student in the Victoria University of Wellington Faculty of Health (Te Wāhanga Tātai Hauora, Te Herenga Waka). He was a summer scholar at the Health Services Research Centre/ Te Hikuwai Rangahau Hauora in 2019/20 and was responsible for conducting an analysis on access to primary health care for Pacific people, using New Zealand Health Survey data. He is currently writing this up for publication.

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