title: Major inequities between district health boards in referred services expenditure: a critical challenge facing the primary health care strategy.
abstract: OBJECTIVE
  This study examines variation between district health boards (DHBs) in expenditure on referred services (ie, pharmaceutical and laboratory services), and compares the gap between budgets as determined by the primary care funding formula and actual expenditure on these services. It also analyses the relationship between population need factors and variation from equity.
  
  
  METHODS
  Actual DHB referred services expenditure related to GPs for the period July to November 2001 was obtained from the Ministry of Health and compared with expected expenditure calculated from the funding formula. Percentage difference between actual and expected expenditure was calculated for each DHB. Data were also obtained relating to DHB populations (numbers with community services cards (CSCs), ethnicity, and scores by NZDep96 quintiles) and number of GPs. The data were used to calculate rates for these variables, which were then correlated with percentage variation from equity in DHB referred services expenditure.
  
  
  RESULTS
  The analysis showed wide percentage variation from equity between DHBs, with Capital and Coast being 17.5% above and Tairawhiti 23.9% below equity. The analysis also showed a high and significant correlation between this inequity and four measures of disadvantage--population per GP, percentage with CSC, percentage of Maori, and NZDep96 scores--which, together, explained more than 50% of the total variation between DHBs. Population per GP was found to be the most significant predictor of variation.
  
  
  CONCLUSIONS
  The inverse care law, ie, that those populations in greatest need are those least likely to receive the services they need, remains a dominant feature of New Zealand s primary care system. This is linked to the gross historical underfunding of access to primary care services. A major redistribution of primary care resources, including GPs, supported by much greater investment in better information and research and development, will be critical to the implementation of the government s Primary Health Care Strategy.
authors.affiliation: Aotearoa Health, New Zealand. lm@cyberxpress.co.nz
authors.forename: Laurence
authors.initials: L
authors.lastname: Malcolm
mesh_terms: D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D009520:New Zealand; D010593:Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D012017:Referral and Consultation / Q000191:economics*