Grant C C, Forrest C B, Starfield B
Department of Paediatrics, University of Auckland School of Medicine, New Zealand.
N Z Med J. 1997 Feb 14;110(1037):35-9.
(1) To describe New Zealand's primary care system (2) to compare New Zealand to other Anglo-American members of the OECD with respect to the adequacy of primary care, and (3) to assess the cost-efficiency and effectiveness of New Zealand's system by comparing health spending and health indicators relevant to primary care.
A cross-national comparison of primary care, health spending and health indicators in New Zealand, Australia, Canada, the United Kingdom and the United States of America. Main outcome measures were health spending measured in purchasing power parties. Health indicators: mean life expectancy in years, years of potential life lost and infant mortality rates.
New Zealand's primary care system ranked below the UK, above the USA and similar to Canada and Australia. Favourable characteristics of New Zealand's primary care system were the use of generalists as the predominant type of practitioner and the low proportion of active physicians who were specialists. Compared to the other countries, New Zealand scored poorly for financial that are necessary for the practise of good primary care. New Zealand and the UK had the lowest spending per capita on health care. New Zealand and the USA scored lowest for all three of the health care indicators.
The quality of primary care in New Zealand is limited by barriers to access to care and the intermediate level of practise characteristics essential to primary care. Compared to other AngloAmerican OECD nations, New Zealand has relatively low levels of national health expenditure. In order to improve the quality of primary care, future reform should aim to facilitate access to care, increase the gatekeeping role of primary care physicians, and promote the practise characteristics essential to primary care.
（1）描述新西兰的初级保健系统；（2）就初级保健的充足性将新西兰与经合组织其他英美成员国进行比较；（3）通过比较与初级保健相关的卫生支出和卫生指标，评估新西兰系统的成本效益和有效性。
对新西兰、澳大利亚、加拿大、英国和美国的初级保健、卫生支出和卫生指标进行跨国比较。主要结果指标是以购买力平价衡量的卫生支出。卫生指标包括：平均预期寿命（年）、潜在寿命损失年数和婴儿死亡率。
新西兰的初级保健系统排名低于英国，高于美国，与加拿大和澳大利亚相似。新西兰初级保健系统的有利特征是，以全科医生作为主要执业类型，且专科医生在在职医生中所占比例较低。与其他国家相比，新西兰在良好初级保健实践所需资金方面得分较低。新西兰和英国的人均医疗保健支出最低。在所有三项医疗保健指标方面，新西兰和美国得分最低。
新西兰初级保健的质量受到获得医疗服务的障碍以及初级保健必不可少的中等水平实践特征的限制。与其他英美经合组织国家相比，新西兰的国家卫生支出水平相对较低。为了提高初级保健质量，未来改革应旨在促进获得医疗服务的机会，增强初级保健医生的守门人作用，并推广初级保健必不可少的实践特征。
