title: Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand

authors: Whitehead, Jesse

subjects: Science & Technology

abstract: Introduction:  Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.
Methods:  Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients’ homes.
Results:  Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, Māori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas – patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass.
Conclusion:  This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban–rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.

text: Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand Introduction:  Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.
Methods:  Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients’ homes.
Results:  Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, Māori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas – patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass.
Conclusion:  This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban–rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.

year: 2019

title: Introduction

authors: Middleton, Sue

abstract: The editors of this book met and became friends in Wellington in the late 1970s, when we were in our early thirties. We had a lot in common. We were taking time out from school-teaching, had preschool children in the Victoria University Crèche and, having gained our BA degrees in “other” subjects, were completing “bridging” courses required for entry to an MA by thesis in Education.1 We bonded in a student-centred course facilitated by Jack Shallcrass, who encouraged us to work independently on philosophical questions that would inform our theses. In 1979 we each—albeit in different contexts—got to know Geraldine McDonald. And for the next 50 years, our lives, research, publishing, and political activities—sometimes individually and sometimes together—would, from time to time, intertwine with hers.

text: Introduction The editors of this book met and became friends in Wellington in the late 1970s, when we were in our early thirties. We had a lot in common. We were taking time out from school-teaching, had preschool children in the Victoria University Crèche and, having gained our BA degrees in “other” subjects, were completing “bridging” courses required for entry to an MA by thesis in Education.1 We bonded in a student-centred course facilitated by Jack Shallcrass, who encouraged us to work independently on philosophical questions that would inform our theses. In 1979 we each—albeit in different contexts—got to know Geraldine McDonald. And for the next 50 years, our lives, research, publishing, and political activities—sometimes individually and sometimes together—would, from time to time, intertwine with hers.

year: 2019

title: Māori data governance model

authors: Kukutai, Tahu

abstract: This report describes the Māori Data Governance Model that has been designed by Māori data experts for use across the Aotearoa New Zealand public service. Māori data is a taonga that requires culturally grounded models of protection and care. The Model provides guidance for the system-wide governance of Māori data, consistent with the Government’s responsibilities under te Tiriti o Waitangi. The Model is intended to assist all agencies to undertake Māori data governance in a way that is values-led, centred on Māori needs and priorities, and informed by research. This is important because existing government data processes and practices are failing to meet Māori informational needs.

The Vision, Tuia te korowai o Hine-Raraunga – Data for self-determination, enables iwi, hapū and Māori organisations, businesses and communities to pursue their own goals for cultural, social, economic and environmental wellbeing. Eight Data Pou or pillars define critical areas of data governance and specify the actions that should be undertaken to realise six desired outcomes. The Model does not cover every element of data governance; instead, it focuses on key priorities and actions, against which agencies can assess their level of data maturity. The Model explicitly recognises the need for changes to system leadership, policies and legal settings so that Māori can exercise authority over Māori data to reduce unethical data use and strengthen outcomes for individuals, whānau and communities. The report also identifies the need for strategic investment in a Mana Motuhake data system that sits outside of the public sector to ensure iwi and hapū sovereignty over iwi and hapū data.

text: Māori data governance model This report describes the Māori Data Governance Model that has been designed by Māori data experts for use across the Aotearoa New Zealand public service. Māori data is a taonga that requires culturally grounded models of protection and care. The Model provides guidance for the system-wide governance of Māori data, consistent with the Government’s responsibilities under te Tiriti o Waitangi. The Model is intended to assist all agencies to undertake Māori data governance in a way that is values-led, centred on Māori needs and priorities, and informed by research. This is important because existing government data processes and practices are failing to meet Māori informational needs.

The Vision, Tuia te korowai o Hine-Raraunga – Data for self-determination, enables iwi, hapū and Māori organisations, businesses and communities to pursue their own goals for cultural, social, economic and environmental wellbeing. Eight Data Pou or pillars define critical areas of data governance and specify the actions that should be undertaken to realise six desired outcomes. The Model does not cover every element of data governance; instead, it focuses on key priorities and actions, against which agencies can assess their level of data maturity. The Model explicitly recognises the need for changes to system leadership, policies and legal settings so that Māori can exercise authority over Māori data to reduce unethical data use and strengthen outcomes for individuals, whānau and communities. The report also identifies the need for strategic investment in a Mana Motuhake data system that sits outside of the public sector to ensure iwi and hapū sovereignty over iwi and hapū data.

year: 2023