Abstract
Objectives: Examine patterns in declined referrals to secondary healthcare in New Zealand by sociodemographics, region, health specialty and over time, as an important marker of potential unmet healthcare need (UMN) for specialist care. The primary hypothesis was that UMN varies by sociodemographic groups, region and health specialty and has increased over time.
Design: A repeated cross-sectional analysis using administrative data from the National Patient Flow (NPF) Collection (2018-2022).
Setting: Nationwide, encompassing all first specialist assessments (FSA) referrals to public hospital specialists in New Zealand.
Participants: Individuals referred by general practitioners for FSA.
Outcome measure: The primary outcome was FSA referrals being declined at prioritisation.
Results: Among 2 918 557 first referrals for FSA, the observed rate of declined at prioritisation was 13.1%. Among those referred, females had a significantly higher risk of being declined (relative risk (RR), 1.069; 95% CI, 1.062 to 1.075), while those in younger (0-9 years: RR, 0.853; 95% CI, 0.841 to 0.865 and 10-19 years: RR, 0.891; 95% CI, 0.879 to 0.904) and older (80+years: RR, 0.955; 95% CI, 0.944 to 0.967) age groups as well as Māori (RR, 0.817; 95% CI, 0.810 to 0.824) and Pacific peoples (RR, 0.706; 95% CI, 0.695 to 0.716) had a significantly lower risk. There was also significant variation in risk of being declined by region and health specialty. The overall risk of being declined increased by 4.1% annually (RR, 1.041; 95% CI, 1.039 to 1.044). Significant increases in risk of declined over time were also observed across all sociodemographic groups, with higher risks for non-Māori/non-Pacific individuals (RR, 1.045; 95% CI, 1.043 to 1.048) and those in less deprived areas (RR, 1.057; 95% CI, 1.052 to 1.063).
Conclusions: UMN in New Zealand has significantly increased, exacerbating health inequities and straining primary care. Policy interventions are urgently needed to address these disparities, particularly in high-risk specialties and populations. This method of quantifying an important marker of UMN may inform global health equity initiatives.