Purpose
This study analysed the prevalence of barriers to seeing a GP at two ages, the persistence of these barriers from age 24 to 45 months, as reported by mothers of participants in the Growing up in New Zealand cohort. We also investigated whether similar barriers were experienced in accessing childhood vaccinations. Finally, we report on the consequences of experiencing a barrier to seeing a GP. Descriptive analyses were used to investigate the prevalence of barriers. Logistic regression was used to investigate the consequences of these barriers.
Methodology
The study was based on an analysis of repeated waves of data collected from the mothers of children enrolled in GUiNZ, a contemporary child cohort study in Aotearoa New Zealand. Details of the cohort’s design and methods have been reported elsewhere [21]. Briefly, pregnant women residing in three adjacent District Health Board (DHB) regions, Auckland, Counties Manukau and Waikato, with an expected delivery date between 25th April 2009 and 25th March 2010 were eligible for inclusion. Recruitment methods included informing women of the study through their lead maternity carer, as well as community actions to increase awareness and participation. Full details of the strategies used have been described elsewhere [22]. A total of 6,846 babies were included in the cohort, representing 35% of all live births in the three DHBs.
Data collection waves relevant to the analysis conducted here were computerassisted face-to-face-interviews with the mother/primary caregiver when the child was 9 months (in 2010), 24 months (in 2011/12) and 54 months old (in 2013/14). At each of these data collection waves, children in the study were eligible for zero-fees GP visits. Secondary care is free for all citizens and residents in Aotearoa New Zealand.
Key Results
Overall, 4.7% of children experienced barriers to seeing a GP at age 12 months to 24 months, as reported by their mother or caregiver. More Māori (8.3%) and Pacific (7.0%) children, compared to NZ European children (2.8%), experienced these barriers.
Common barriers to seeing a GP across all of the children in the cohort included:
- unable to get an appointment
- after hours
- not having transport
- not being able to spare the time
- cost
- not able to get in touch with a GP; and
- not having childcare
Maori and Pacific children who face barriers to primary care were twice as likely to end up in hospital that those who do not face barriers. Despite the zero-fees policy, some caregivers report not taking their children to see a GP due to cost. This may refer to the perceived cost of a GP appointment, refer to the cost of transport, cost of time off work, childcare for other children in the family or could be due to children not being enrolled in a practice, so not being eligible for free visits.
The researchers say this study reflects the disproportionate experience of barriers to seeing a GP among Māori and Pacific children, and highlights the inequity in the provision of primary health care in Aotearoa New Zealand. The researchers suggest policy makers consider how to reduce barriers to primary health care and reduce hospital admissions among children by prioritising improved access to GPs for Māori and Pacific people, promoting children’s’ eligibility for free GP visits, carefully considering the locations of primary care services, and ensuring future health policies align with contemporary interpretations of Te Tiriti o Waitangi.