Bowden Nicholas, Bateman Jerram, Gauld Robin
Department of Paediatrics and Child Health, University of Otago, Dunedin, New Zealand.
University of Canterbury, Christchurch, New Zealand.
BMJ Open. 2025 Sep 2;15(9):e099726. doi: 10.1136/bmjopen-2025-099726.
Examine patterns in declined referrals to secondary healthcare in New Zealand by sociodemographics, region, health specialty and over time, as an important marker of potential unmet healthcare need (UMN) for specialist care. The primary hypothesis was that UMN varies by sociodemographic groups, region and health specialty and has increased over time.
A repeated cross-sectional analysis using administrative data from the National Patient Flow (NPF) Collection (2018-2022).
Nationwide, encompassing all first specialist assessments (FSA) referrals to public hospital specialists in New Zealand.
Individuals referred by general practitioners for FSA.
The primary outcome was FSA referrals being declined at prioritisation.
Among 2 918 557 first referrals for FSA, the observed rate of declined at prioritisation was 13.1%. Among those referred, females had a significantly higher risk of being declined (relative risk (RR), 1.069; 95% CI, 1.062 to 1.075), while those in younger (0-9 years: RR, 0.853; 95% CI, 0.841 to 0.865 and 10-19 years: RR, 0.891; 95% CI, 0.879 to 0.904) and older (80+years: RR, 0.955; 95% CI, 0.944 to 0.967) age groups as well as Māori (RR, 0.817; 95% CI, 0.810 to 0.824) and Pacific peoples (RR, 0.706; 95% CI, 0.695 to 0.716) had a significantly lower risk. There was also significant variation in risk of being declined by region and health specialty. The overall risk of being declined increased by 4.1% annually (RR, 1.041; 95% CI, 1.039 to 1.044). Significant increases in risk of declined over time were also observed across all sociodemographic groups, with higher risks for non-Māori/non-Pacific individuals (RR, 1.045; 95% CI, 1.043 to 1.048) and those in less deprived areas (RR, 1.057; 95% CI, 1.052 to 1.063).
UMN in New Zealand has significantly increased, exacerbating health inequities and straining primary care. Policy interventions are urgently needed to address these disparities, particularly in high-risk specialties and populations. This method of quantifying an important marker of UMN may inform global health equity initiatives.
通过社会人口统计学、地区、医疗专科以及时间维度，研究新西兰二级医疗转诊减少的模式，以此作为专科护理潜在未满足医疗需求（UMN）的重要指标。主要假设是UMN因社会人口统计学群体、地区和医疗专科而异，且随时间推移有所增加。
使用来自国家患者流向（NPF）数据集（2018 - 2022年）的行政数据进行重复横断面分析。
全国范围，涵盖所有转诊至新西兰公立医院专科医生的首次专科评估（FSA）。
由全科医生转诊进行FSA的个体。
主要观察指标是FSA转诊在优先级排序时被拒绝。
在2918557例首次FSA转诊中，观察到的优先级排序时被拒绝率为13.1%。在被转诊者中，女性被拒绝的风险显著更高（相对风险（RR），1.069；95%置信区间，1.062至1.075），而年龄较小（0 - 9岁：RR，0.853；95%置信区间，0.841至0.865以及10 - 19岁：RR，0.891；95%置信区间，0.879至0.904）和年龄较大（80岁及以上：RR，0.955；95%置信区间，0.944至0.967）的人群以及毛利人（RR，0.817；95%置信区间，0.810至0.824）和太平洋岛民（RR，0.706；95%置信区间，0.695至0.716）被拒绝的风险显著更低。地区和医疗专科之间在被拒绝风险方面也存在显著差异。被拒绝的总体风险每年增加4.1%（RR，1.041；95%置信区间，1.039至1.044）。在所有社会人口统计学群体中，随时间推移被拒绝风险也显著增加，非毛利/非太平洋岛民个体（RR，1.045；95%置信区间，1.043至1.048）以及生活在贫困程度较低地区的人群（RR，1.057；95%置信区间，1.052至1.063）风险更高。
新西兰的UMN显著增加，加剧了健康不平等并给初级保健带来压力。迫切需要政策干预来解决这些差异，特别是在高风险专科和人群中。这种量化UMN重要指标的方法可能为全球健康公平倡议提供参考。
