Investigating Postcode Lottery: Do Regional Outreach Clinics Improve Waiting Times to Elective General Surgical Care...

Health inequities, particularly for rural and Māori populations, persist in Aotearoa New Zealand (NZ) due to geographical and structural barriers to accessing healthcare. Te Whatu Ora-Health NZ aims to reduce these inequities, including through rural outreach clinics. This study evaluates the impact of rural outreach general surgical clinics in the Hawkes Bay region on access to benign elective surgeries for rural and Māori populations.

A retrospective cohort study was conducted on all adult patients who underwent elective general surgery in Hawkes Bay from August 2015 to December 2023. Data on patient demographics, ethnicity, rural status, clinic type and surgery type were collected. Primary outcomes were time from referral to first specialist assessment (FSA), waitlist to surgery and total time from referral to surgery. Data were analysed using chi-square and Mann-Whitney U-tests, with statistical significance set at p < 0.05.

One thousand three hundred and ninety-seven patients met the criteria, of whom 19.4% (N = 271) resided rurally, and 24.1% (N = 337) identified as Māori. Rural patients had a longer median waitlist-to-surgery time (95.0 vs. 83.0 days, p = 0.006) and overall referral-to-surgery time (143.0 vs. 129.0 days, p = 0.04) compared with urban patients. Māori patients waited longer for surgery than non-Māori patients (p = 0.088). Outreach clinics had longer overall wait times than central clinics (p = 0.003).

Despite outreach clinics in our district, rural and Māori patients experience longer delays in receiving elective surgery. Additional investment in rural outreach clinics and equity-focused prioritisation could improve access and reduce healthcare disparities for these populations. Further qualitative research is needed to explore patient perspectives.