General practitioner funding policy: from where to whither?

Area of Science:

• Public Health Policy
• Primary Care Management
• Health Economics

Background:

• Analysis of six public policy objectives for general practitioner (GP) funding in New Zealand since 1938.
• Objectives include national health insurance, rural GP shortages, care for the poor, health promotion, cost-effectiveness, and community control.

Purpose of the Study:

• To evaluate the success of past public policies in meeting identified GP funding objectives.
• To discuss theoretical principles of efficient public policy development in the context of New Zealand's GP funding.
• To explore emerging consensus on targeted programs for the poor and the balance with market-based arrangements.

Main Methods:

• Historical review and analysis of public policy objectives and their outcomes.
• Examination of the extent to which each objective has been met by past policies.
• Discussion of theoretical principles of public policy and their application to New Zealand's GP funding.

Main Results:

• Past GP funding policies have been, at best, only partially successful in meeting their stated objectives.
• Previous policies required minimal dismantling before the introduction of new initiatives post-1993.
• New Zealand's GP funding policies have rarely conformed to established principles of efficient and coherent public policy.

Conclusions:

• There is a need for GP funding policies to better align with theoretical principles for efficiency and coherence.
• An emerging consensus favors targeted programs for low-income groups, balancing equity and efficiency.
• Key policy decisions involve balancing planned primary care for the poor with market-based systems for others.