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dc.contributor.advisorAtatoa-Carr, Polly
dc.contributor.advisorPearson, Amber L.
dc.contributor.advisorLawrenson, Ross
dc.contributor.authorWhitehead, Jesse
dc.date.accessioned2020-10-28T02:54:15Z
dc.date.available2020-10-28T02:54:15Z
dc.date.issued2020
dc.identifier.citationWhitehead, J. (2020). The spatial equity and sustainability of general practitioner services: A mixed methods analysis of the Waikato DHB region (Thesis, Doctor of Philosophy (PhD)). The University of Waikato, Hamilton, New Zealand. Retrieved from https://hdl.handle.net/10289/13929en
dc.identifier.urihttps://hdl.handle.net/10289/13929
dc.description.abstractThe New Zealand Primary Health Care Strategy states that quality primary health care is the first level of contact with the health system and should be universally accessible. Effective primary health care is an essential component of health systems, and is associated with more equitable distributions of health outcomes. However, not all New Zealanders have ready access to primary health care. For instance, adult residents of the Waikato region, and in particular Māori, have higher levels of unmet need for primay care than others. Improving the spatial equity of health services is a key step in achieving health equity. Health systems should contribute to achieving health equity and maintaining sustainable and equitable services into the future. This thesis research examines the spatial equity and sustainability of general practitioner (GP) services in the Waikato DHB region, using a mixed-methods approach to identify not only where inequities exist, but why they occur. A conceptual framework establishes a foundation for examining spatial equity and sustainability in New Zealand. Next, a systematic literature review identifies common definitions and measures of spatial equity. Primary Health Organisation (PHO) enrolment data is used to examine patterns of patient enrolment at GP services, and a range of health needs indicators were assessed for their suitability in the New Zealand primary care context. These findings inform the development of a Geographic Information Systems (GIS) model of spatial accessibility that is tailored to the Waikato District Health Board (DHB) context. The GIS model is then used, in combination with in-depth qualitative interviews, to examine the spatial equity and sustainability of GP services in the Waikato DHB region. Key findings include that spatial equity is commonly defined as a ‘need-based distribution of resources’, which can be quantified using a range of statistical and geospatial measures and techniques. PHO enrolment analysis revealed that most patients do not enrol with their closest service, and that the size of the ‘catchment area’ served by GP clinics varies with rurality. Analysis of indicators of health need suggest that ‘Ambulatory Sensitive Hospitalisations’ are a robust indicator; however, area-level socioeconomic deprivation is also strongly associated with other indicators of need and data is more widely available to researchers. Mixed-methods analysis suggests that GP services are not distributed equitably within the Waikato DHB region and that key barriers to access include the affordability, appropriateness, and availability of services. New Zealand’s history of colonisation and discrimination are identified as fundamental drivers of health inequity. Furthermore, population growth and ageing suggest that current levels of access to GP services are unlikely to be maintained in the future, while participants identify key economic, professional, organisation, and social dimensions that influence service sustainability in New Zealand.
dc.format.mimetypeapplication/pdf
dc.language.isoen
dc.publisherThe University of Waikato
dc.rightsAll items in Research Commons are provided for private study and research purposes and are protected by copyright with all rights reserved unless otherwise indicated.
dc.subjectspatial equity
dc.subjectprimary care
dc.subjecthealth geography
dc.subjectsustainability
dc.subjecthealth equity
dc.subjectMedical care, Cost of -- New Zealand -- Waikato -- Analysis
dc.subject.lcshMedical care, Cost of -- New Zealand -- Waikato -- Analysis
dc.titleThe spatial equity and sustainability of general practitioner services: A mixed methods analysis of the Waikato DHB region
dc.typeThesis
thesis.degree.grantorThe University of Waikato
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Philosophy (PhD)
dc.date.updated2020-10-28T02:00:35Z
pubs.place-of-publicationHamilton, New Zealanden_NZ


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