title: Does community-governed nonprofit primary care improve access to services? Cross-sectional survey of practice characteristics.
abstract: This study compared community-governed nonprofit and for-profit primary care practices in New Zealand to test two hypotheses: (1) nonprofits reduce financial and cultural barriers to access; and (2) nonprofits do not differ from for-profits in equipment, services, service planning, and quality management. Data were obtained from a nationally representative cross-sectional survey of GPs. Practices were categorized by ownership status: private community-governed nonprofit or private for-profit. Community-governed nonprofits charged lower patient fees per visit and employed more Maori and Pacific Island staff, thus reducing financial and cultural barriers to access compared with for-profits. Nonprofits provided a different range of services and were less likely to have specific items of equipment; they were more likely to have written policies on quality management, complaints, and critical events, and to carry out locality service planning and community needs assessments. The findings support the shift to nonprofit community governance occurring in New Zealand and elsewhere.
authors.affiliation: Department of Public Health, Wellington School of Medicine and Health Sciences, New Zealand. peter.crampton@otago.ac.nz
authors.forename: Peter
authors.initials: P
authors.lastname: Crampton
authors.forename: Peter
authors.initials: P
authors.lastname: Davis
authors.forename: Roy
authors.initials: R
authors.lastname: Lay-Yee
authors.forename: Antony
authors.initials: A
authors.lastname: Raymont
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
authors.forename: Barbara
authors.initials: B
authors.lastname: Starfield
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D005251:Fees, Medical; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000458:organization & administration; D006801:Humans; D009520:New Zealand; D009939:Organizations, Nonprofit; D010067:Ownership / Q000145:classification; D010821:Physicians, Family / Q000191:economics / Q000458:organization & administration / Q000600:supply & distribution*; D011320:Primary Health Care / Q000458:organization & administration*