Langton Jennifer, Crampton Peter
Pharmacy Department, Capital and Coast District Health Board, Wellington, New Zealand.
N Z Med J. 2008 Apr 18;121(1272):47-58.
To determine whether the three main funding formulas for Primary Health Organisations achieved a stated aim of the Primary Health Care Strategy to fund enrolled populations according to need.
National data were obtained from the Ministry of Health for a 12-month period beginning in April 2004: these included demographic characteristics of the enrolled Primary Health Organisation population, plus rates tables for: First-Contact Services, Services to Improve Access, and Health Promotion. Funding for Access and Interim practices for four-quarters was calculated for each of these three funding streams. Analysis of the demographic characteristics of Access and Interim practices was undertaken.
Maori and Pacific peoples made up a greater proportion of the Access population than the Interim, had higher rates of deprivation than the non-Maori/non-Pacific population, and demonstrated a younger age distribution. The first quarter (April 2004-June 2004) showed there was preferential funding for Access PHOs and in particular high-needs groups. In quarter two, this level of preferential funding had diminished, coinciding with the introduction of increased government funding for all Interim enrolees aged 65 and over.
The greater funding for Access enrolees was notably eroded with the introduction of Access-level funding for those aged 65+ in Interim PHOs. Since these data were analysed all remaining Interim age groups have shifted to Access-level funding, benefiting non-Maori /non-Pacific in Interim PHOs. The rapid shift to Access-level funding for First Contact Services has seen a continued erosion of the redistributive effect of the original needs-based formulas. A system cannot be considered equitable if some members of society are not realising their health potential, and financing of primary care should remain redistributive until such a time as this objective is attained.
确定初级卫生保健组织的三种主要资金分配方案是否实现了初级卫生保健战略中根据需求为登记人口提供资金的既定目标。
从卫生部获取了从2004年4月开始的12个月期间的全国数据：这些数据包括登记的初级卫生保健组织人口的人口统计学特征，以及以下方面的费率表：首次接触服务、改善就医机会服务和健康促进。计算了这三个资金流中每一个的四个季度的就医机会和临时医疗机构的资金。对就医机会和临时医疗机构的人口统计学特征进行了分析。
毛利人和太平洋岛民在就医机会人口中所占比例高于临时医疗机构人口，贫困率高于非毛利/非太平洋岛民人口，且年龄分布更年轻。第一季度（2004年4月至2004年6月）显示，就医机会初级卫生保健组织，特别是高需求群体获得了优先资金。在第二季度，这种优先资金水平有所下降，与此同时，政府为所有65岁及以上的临时登记人员增加了资金投入。
随着为临时初级卫生保健组织中65岁及以上人群引入就医机会水平的资金，对就医机会登记人员的更多资金明显减少。自从分析这些数据以来，所有剩余的临时年龄组都已转向就医机会水平的资金，这使临时初级卫生保健组织中的非毛利/非太平洋岛民受益。向首次接触服务的就医机会水平资金的快速转变，导致了原基于需求的方案的再分配效应持续受到侵蚀。如果社会中的一些成员没有发挥其健康潜力，就不能认为一个系统是公平的，并且在实现这一目标之前，初级保健的融资应保持再分配性质。
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