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Despite having poorer health outcomes than their urban counterparts, rural New Zealanders are considerably less likely to be admitted to hospital, a University of Otago-led study has found.

Published in the New Zealand Medical Journal, it is the first time large rural-urban differences have been demonstrated in utilisation of hospital services in the country.

Garry Nixon image
Professor Garry Nixon.

Lead author Professor Garry Nixon, Head of Rural Section in Otago’s Department of General Practice and Rural Health, says the results are surprising given rural New Zealanders have poorer health outcomes, including higher preventable mortality rates.

“The problem is even greater for our most remote communities.

“Despite the poorest health outcomes, highest levels of socioeconomic deprivation and the highest proportion of Māori residents, these areas have the lowest hospital admission rates and lowest utilisation of other hospital services such as emergency departments, specialist clinics and allied health services,” he says.

The findings also go against the pattern seen in similar countries – in Australia and Canada, the poorer health status and lack of access to primary care services results in higher hospital admissions for residents of rural areas.

“It’s unclear why this is not also the case in New Zealand, raising the possibility of poorer access to hospital services for rural communities.”

The study used hospitalisation, allied health, emergency department and specialist outpatient data from 2014 to 2018, along with Census information, to calculate hospital utilisation rates for residents in the two urban and three rural categories.

The researchers found, overall, regional centres had the highest hospitalisation rates, and rural areas the lowest.

Relative to their urban peers, rural people had lower all-cause, cardiovascular, mental health, and ambulatory sensitive hospitalisation rates.

Those living in the most remote communities had the lowest rates of specialist outpatient and emergency department attendance, an effect that was accentuated for Māori.

Professor Nixon believes there needs to be better monitoring of healthcare utilisation to help reduce these inequities.

“This is not only between regions as has been the case in the past – like the post code lottery – but also between neighbouring rural and urban areas. Accurate data is needed to provide evidence for policy and health service planning.”

He believes the important role of rural hospitals have in reducing these disparities also needs to be acknowledged.

“In recent decades they have received little attention by the larger health service and are in need of specific strategy and funding models that ensure their sustainability,” he says.

In addition to utilisation of hospital services, the researchers believe primary care access and utilisation are an important part of the rural-urban equity puzzle. Since New Zealand currently lacks a nationally consistent primary care dataset, the researchers plan to explore this when data is available.

Publication details:

Rural–urban variation in the utilisation of publicly funded healthcare services: an age-stratified population-level observational study

Garry Nixon, Gabrielle Davie, Jesse Whitehead, Rory Michael Miller, Brandon de Graaf, Talis Liepins, Ross Lawrenson, Sue Crengle

New Zealand Medical Journal (23 February, 2024 edition)

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