Health equity in the New Zealand health care system: a national survey

International Journal for Equity in Health

Research

Allan Moffitt¹  Martin J Connolly²  Timothy W Kenealy³  John Kolbe⁴  Robert Doughty⁴  P Alan Barber⁴  Ross Lawrenson⁵  Gerard Devlin⁵  Nicolette F Sheridan⁶  Janet Clinton⁷  Lorna Dyall⁷  Peter Carswell⁷  Faith Mahony⁷  Ngaire Kerse⁷  Mary Anne Boyd⁸ 

[1] Counties Manukau District Health Board, South Auckland, New Zealand;Freemasons' Department of Geriatric Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;Waitemata District Health Board, North Shore, Auckland, New Zealand;School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;Auckland District Health Board, Central Auckland, New Zealand;School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;Waikato District Health Board, Hamilton, New Zealand;School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;Waitemata District Health Board, North Shore, Auckland, New Zealand;

关键词: health equity;    Māori;    cultural competency;    health care system;    chronic conditions;    cardiovascular disease;    chronic obstructive pulmonary disease;    congestive heart failure;    stroke;    diabetes;   

DOI  :  10.1186/1475-9276-10-45

 received in 2011-06-06, accepted in 2011-10-20,  发布年份 2011

来源: Springer

【 摘 要 】

IntroductionIn all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable.MethodsA national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes.ResultsSurvey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment.ConclusionsThere is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.

【 授权许可】

CC BY   
© Sheridan et al; licensee BioMed Central Ltd. 2011