Better after-hours care access for youngsters

28 August 2014

Reducing the cost of subsidised co-payments appears to have led to an increase in the number of children under six using after-hours accident and medical clinics, according to research from the University of Auckland.

A recent report, written by lead health policy researcher Dr Tim Tenbensel from the School of Population Health, evaluates initiatives designed to reduce barriers to accessing after-hours and urgent medical care in the Auckland region.

These initiatives, sponsored by the Greater Auckland Integrated Health Network, include the Accident and Medical (A&M) intervention, which introduced subsidised co-payments and increased opening hours to 11 participating A&M clinics across Auckland.

The research was funded by the Health Research Council of New Zealand in partnership with the Ministry of Health.  It was commissioned under the government’s Better, Sooner, More Convenient Primary Health Care initiative, which aims to deliver a more personalised primary health care system that provides services closer to home and makes Kiwis healthier.

Following the introduction of the A&M initiative in September 2011, the report’s researchers found there was a 13 percent increase (8600 patients) in the number of patients eligible for subsidised co-payments* using the participating A&M clinics. The number of patients aged over 65 using A&M clinics was higher than predicted (although still low); however, the biggest indication of a positive effect was for children under six years.

“We are confident that increases in the use of accident and medical clinics, particularly for children under the age of six, can be attributed to the A&M intervention, says Dr Tenbensel. “This is based on economic analysis of the data, which shows that reducing co-payments to zero had a strong influence on the use of A&M clinics by under-six-year-olds in low income neighbourhoods.”

These results corresponded with an estimated 10 percent (7000 patients) drop in the number of eligible patients presenting to hospital emergency departments, but Dr Tenbensel emphasised that this decrease cannot necessarily be attributed to the A&M intervention, because of other confounding factors.

The report also evaluated two other initiatives: an after-hours telephone triage service offered by HomeCare Medical Limited (HML), (where patients can call their GP after hours), and the St John Transport (SJT) Initiative, which aims to reduce the number of patients St John Ambulance services transports to emergency departments who can be safely managed in the community.

Awareness of the HML service was found to be low, with only 10 per cent of surveyed patients aware that their family doctor provided an after-hours telephone service.

Over the first 24 months of the SJT Initiative (December 2011 to November 2013), 2967 patients were diverted by ambulance to an Auckland A&M clinic. In 88 per cent of these transfers, patients were successfully managed in primary care, while 10 per cent were referred on to hospital.

The report concluded that the SJT Initiative had made a “small difference” to patients’ use of A&M clinics and hospital emergency departments. Surveys of ambulance patients showed that those who were transferred to A&M clinics were satisfied with their care as long as they were seen by a doctor or nurse on arrival.

Dr Tenbensel says, “While it is too early to expect these initiatives to show positive results, the report does indicate the key issues to address if these services are to play a positive role.”

“The value in all the initiatives lies more in the processes by which they came about – as a consequence of constructive engagement between Auckland region health organisations – and less in the capacity of these instruments to quickly solve endemic, structural health system problems,” says Dr Tenbensel.

To download a copy of the full report, go to

* Patients eligible for subsidised co-payments include children aged under six; patients aged 65 and over; holders of High User Health Cards; holders of Community Service Cards; and residents of Deprivation 9 and 10 areas according to the Census (2006).


For more information contact;


Dr Tim Tenbensel

School of Population Health, the University of Auckland.

Phone: 09 373 7599 ext. 89001 or email:



Suzi Phillips, Media Relations Advisor, Faculty of Medical and Health Sciences,

Communications, the Vice-Chancellor’s Office, University of Auckland.

Email or Tel +64 9 923 7383 or Mob 021416396

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