title: Good progress for children coupled with recalcitrant inequalities for adults in New Zealand's journey towards Universal Health Coverage over the last decade.
abstract: OBJECTIVE
  This article explores how primary health care policy changes in New Zealand over the last decade have impacted on primary care access equity and avoidable hospital admissions.
  
  
  METHODS
  The national Ambulatory Sensitive Hospitalisations (ASH) data trends by age, ethnicity and area level deprivation were analysed in relation to the Primary Health Care policy initiatives for the period 2002 to 2014.
  
  
  CONCLUSIONS
  Changes in primary care access over the decade have led to improvement in ASH indicators for parts of the population, but not for others. ASH rates decreased very significantly for children, especially in the 0-4 age group. These trends began in 2004, with decreases most marked for Pacific children, and those from the most deprived neighbourhoods. Inequalities in ASH rates for children between ethnic groups and levels of deprivation have substantially decreased. On the other hand, there has been a significant increase in ASH rates and inequalities for Pacific peoples in the 45 to 64 age group. Māori in the same age band show a modest reduction in ASH rates, with inequalities compared with the rest of the population remaining unchanged. Inequalities in ASH rates between 45-65 year olds living in different levels of deprivation remain large and unchanged, indicative of the recalcitrant nature of inequalities in primary care access for the adult population. Major policy initiatives undertaken by the government during this period have significantly affected primary care access. These include the New Zealand Health Strategy, the Primary Health Care Strategy, the creation of District Health Boards and Primary Health Organisations, and free care to under 6-year-olds. In the latter part of the decade, high-level target setting by successive Ministers is also affecting system performance. We conclude that the success in reducing inequality in access to primary care for children needs to be intensified, and the same principles applied to the adult population groups.
authors.affiliation: Health Systems Consultant, Brisbane, Australia, +61 41 132 6463. d.p.matheson@massey.ac.nz.
authors.forename: Don
authors.initials: D
authors.lastname: Matheson
authors.forename: Johanna
authors.initials: J
authors.lastname: Reidy
authors.forename: Lee
authors.initials: L
authors.lastname: Tan
authors.forename: Julia
authors.initials: J
authors.lastname: Carr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care; D063127:Secondary Health Care; D012923:Social Class; D019472:Universal Health Insurance / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult