Holes in the safety net? Assessing the effects of targeted benefits upon the health care utilization of poor New Zealanders

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Abstract
This paper examines the issue of targeting primary health‐care benefits in favour of low‐income recipients and other high users of health care. Specifically we examine the New Zealand case where, despite the introduction of such benefits in 1992, financial barriers appear to remain a significant determinant of utilization. We address this issue through a case study conducted in the city of Christchurch. Through a survey‐based research design, we seek to determine the extent to which price barriers remain important by comparing patient utilization of a free community health clinic (n = 202) with a low‐income control sample of patients who continue to use conventional (for New Zealand) fee‐for‐service providers (n = 148). We found that a large proportion of respondents delayed seeking care because of cost. Further, for respondents using the fee‐for‐service providers, levels of use were not related to need, whereas at the free clinic there was an inverse relationship between income and consultation rates. We conclude that if a universality of benefits is not possible, then there is a need for better targeting of primary care benefits. We believe there is a danger in such initiatives being evaluated primarily in terms of their validity as funding mechanisms, rather than in terms of their success in meeting the health‐care needs of the disdavantaged.