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PubMed1999

Shifting to capitation in primary care: what might the impact be in New Zealand?

Primary medical care in New Zealand has traditionally been delivered by general practitioners and funded by a mix of fee-for-service government subsidies, user part-charges and private payments. In 1998, New Zealand's national purchaser of publicly-funded health care, the Health Funding Authority, proposed to pay health service organisations capitation fees per enrolled patient, as well as fees-for-service for immunisations and some performance-related payments. This article considers the implications, drawing on theory and research from New Zealand and elsewhere, of different methods for paying general practitioners and other primary care professionals. The main focus is on whether giving a greater emphasis to capitation will lead to a fairer distribution of resources and better access to services for those groups of people who are not well served by the current system.

Adult↗
PubMed1995

Post-1945 international migration: New Zealand, Australia and Canada compared.

"New Zealand's immigration policies and trends since 1945 are compared with those of Canada and Australia. For most of this period, Australia has pursued the more expansive immigration policy while Canada and New Zealand have tended to link immigration intakes to fluctuations in labor demand. All three countries initially discriminated against non-European immigrants but gradually moved towards nondiscriminatory policies based on similar selection criteria and means of assessment. New Zealand has traditionally been more cautious than both Canada and Australia in terms of how many immigrants it accepted and from what sources, but it has recently followed the other two in raising immigration targets encouraging migration from nontraditional sources, particularly Asian countries. Historical, global and national factors are drawn upon to explain the degree of convergence between these three societies."

Americas↗
PubMed2004

How mental health clinicians view community treatment orders: a national New Zealand survey.

OBJECTIVE: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships. METHOD: A national survey of New Zealand psychiatrists and a regional survey of non-psychiatric community mental health professionals for comparison. RESULTS: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use. CONCLUSIONS: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.

Adult↗
PubMed1977

Cancer registry in New Zealand.

Cancer registration, introduced in New Zealand in 1948, evolved from a clinically oriented to a population-based collection scheme. The registry, located within the National Health Statistics Centre, can draw on a wide range of other health data reported to that office. New Zealand has a population of 3 million, 8% of whom are Maoris. Findings indicated that cancer is the second leading cause of death and that Maori women have a much higher overall cancer death toll than other New Zealand women. Significantly higher incidence rates for cancers of the stomach, pancreas, lung, thyroid gland, and uterus and lower rates for cancer of the large bowel and melanoma of the skin were found in Maoris.

Adolescent↗
PubMedDate not supplied

New Zealand health care: a background.

New Zealand, its people and health care services are described, followed by a discussion of (i) the role of government and non-government agencies in the funding, provision and purchasing of health care and (ii) persistent problems in the health care system. The authors argue that recent New Zealand health care reforms represent a significant deviation from past policies. However, to have any prospect of being judged as successful, the reforms must address difficulties in the funding, purchasing and provision of health care that are not new but have been features of New Zealand health care over many years.

Economic Competition↗
PubMed2006

Estimated prevalence of cardiovascular disease and distribution of cardiovascular risk in New Zealanders: data for healthcare planners, funders, and providers.

AIMS: New Zealand cardiovascular risk management guidelines advocate targeted risk assessment based primarily on age, gender, and ethnicity--and recommend drug management for people with a 5-year absolute cardiovascular disease (CVD) risk greater than 15%. To inform service planning and healthcare delivery for district health boards and primary healthcare organisations in New Zealand, we have produced population estimates of CVD prevalence and 5-year absolute CVD risk. METHODS: The 1993 Auckland Heart and Health Study provided the data for estimating CVD prevalence and absolute CVD risk distributions using the Framingham CVD risk prediction equation. These estimates were applied to population projections for 2005 based on 2001 New Zealand Census data. RESULTS: Of the projected 2.09 million people aged over 35 years in New Zealand in 2005, approximately 1.5 million (72%) meet national criteria for formal CVD risk assessment. About 151,000 (7%) are estimated to have suffered a non-fatal heart attack or stroke or have angina. A further 262,000 (13%) are estimated to have a 5-year CVD risk greater than 15% based on New Zealand CVD risk charts. This represents around 1 in 5 adults over the age of 35 years in New Zealand for whom pharmacological interventions are recommended according to the New Zealand CVD risk guidelines for the prevention of new or further CVD events. CONCLUSIONS: The latest published data available on the burden of CVD risk in New Zealand is now over 10 years old and does not include Maori, Pacific, and other non-European ethnic groups. Current data on the risk profile of adult New Zealanders is required for more accurate service planning. However the information reported here provides a reasonable estimate of the magnitude of the task. Although systematic identification and management of CVD risk in New Zealanders with raised CVD risk will be a major undertaking for healthcare services, it has the potential to produce significant health-gains while reducing health disparities.

Adult↗
PubMed1981

Registration of veterinary drugs in Australia and New Zealand.

In both Australia and New Zealand, the objective of clearance for registration and licensing is to ensure safe and efficient use of chemicals and to recognise the special needs of several different interests, namely 1. end-users concerned with efficacy and possible hazards; 2. the consumers of food products from treated animals; 3. stock owners and vendors who need protection from false claims from competitive products; 4. wildlife and other ecological considerations; 5. protection of overseas markets, with special reference to drug and chemical residues. In Australia the Technical Committee on Veterinary drugs is responsible for the preliminary clearance of products for mass-medication with respect to efficacy and safety and, in association with the National Health and Medical Research Council Committees, sets residue limits and establishes poison schedules. This committee, however, can only make recommendations to the individual States, who are responsible for administering regulations through relevant State departments. In New Zealand, the Animal Remedies Act (1967) is responsible for the control of manufacture and importation of animal remedies and for the licensing of these for specific purposes. The Animal Remedies Act is administered by an Animal Remedies Board which operates within the New Zealand Ministry of Agriculture and and Fisheries.

Animal Feed↗
PubMed1987

Time trends and occupational differences in cancer of the testis in New Zealand.

The findings are reported from a New Zealand Cancer Registry-based case-control study involving 427 male patients with testicular cancer registered during the period 1979-1983 and aged 20 years or more at time of registration. Controls were also males chosen from the Cancer Registry with two controls per case, matched on age and year of registration. It was found that, as in other countries, persons in the upper social class groupings were at increased risk of testicular cancer. Persons in professional occupations were also at increased risk, but the odds ratio of 1.09 was much smaller than found in other studies. The previously reported excess risks for farmers, food and beverage workers, forestry workers, and pulp and paper workers were not supported by the New Zealand data. On the other hand, the previously reported excess risk for sales and service workers including members of the armed forces was supported, to some extent, by the New Zealand data with odds ratios of 1.38 (95% confidence limits 0.98-1.93) and 2.15 (95% confidence limits 0.80-5.79), respectively. Other groups with elevated risk include: physicians (odds ratio = 6.50, 95% confidence limits 1.29-32.6); production supervisors (odds ratio = 2.85,95% confidence limits 1.00-8.13); and motor vehicle mechanics (odds ratio = 2.02, 95% confidence limits 0.93-4.42). However, the New Zealand data generally does not suggest that occupational factors (or lifestyle factors associated with occupation) are of major direct importance in the etiology of testicular cancer. The incidence of testicular cancer has a bimodal age distribution in New Zealand and has risen markedly during the period 1948-1979. The New Zealand data differed from patterns observed in other countries in that the relative increase was approximately uniform across age groups rather than being stronger in the younger age groups.

Age Factors↗
PubMed1993

Health and housing--seasonality in New Zealand mortality.

The common belief that New Zealand's climate is mild appears to be supported by the statistics of deaths directly attributable to cold. However an initial analysis of seasonality of mortality using the modified Edwards method suggests New Zealand has a greater seasonality of mortality than the more extreme climates of the United Kingdom, the United States, Australia, Japan or Sweden. Examination of New Zealand monthly mortality from 1976 to 1986 suggests this is driven by the seasonality of mortality of those aged 65 and over. Three surveys of temperatures within New Zealand homes have suggested that few are fully maintained in the 18 degrees C to 24 degrees C comfort range. Mean temperatures close to or below 16 degrees C were found in two of these surveys. Further research is suggested to examine the links between health and housing thermal performance. This research should combine both health and building science knowledge and techniques.

Aged↗
PubMed1993

A history of population movement between New Zealand and Australia.

"Migration between New Zealand and Australia has assumed considerable significance for both countries during the past 25 years. Commencing in the late 1960s, three major waves of net immigration from New Zealand have seen Australia's New Zealand-born population increase from 52,000 at the 1966 Census to 212,000 at the 1986 Census.... This paper aims to set these contemporary trends in historical context. So strong has been the tide flowing towards Australia that it is easy to imagine, erroneously, that it always flowed that way." Movements since the early 1800s are examined. Aspects considered include major periods of net migration, gender balance, short-term and permanent movement, and size and composition of immigrant groups. The impact of changes in migration policies over time is analyzed. The author's name is incorrectly listed as George A. Carmichael on this article. (SUMMARY IN FRE AND SPA)

Australia↗
PubMed1997

Defining core services: New Zealand experiences.

A key aspect of the New Zealand health reforms was the proposed development of an explicit core of services to which all New Zealanders would have access. A range of approaches has been taken by the government, its advisers, purchasers and providers to describe sets of services to which New Zealanders are to have access. The development of an explicit core aims to promote equity of access to services, to ensure that those services available are those that are the most cost-effective and the services New Zealanders feel to be the most important, and to clarify entitlements to publicly funded health care. This paper describes the current approaches that are being used to define core services in New Zealand, discusses the reasons behind some of the choices made and notes some key issues for further policy debate.

Cost-Benefit Analysis↗
PubMed2004

New Zealand's psychiatrist workforce: profile, recruitment and retention.

OBJECTIVE: New Zealand is suspected of sharing other countries' difficulties of having inadequate numbers of practising psychiatrists and attracting psychiatrists to work outside its main urban centres, but there is no contemporary data on the socio-demographic and professional practice profile of its psychiatrists. This paper highlights some interesting trends about New Zealand's psychiatric workforce. METHOD: A postal questionnaire was sent to all actively practising vocationally registered psychiatrists with a New Zealand mailing address requesting information about basic demographic data, professional training experiences, current professional status, practise intentions, why they chose to work where they do and what factors might influence them to leave for another region of New Zealand or overseas. RESULTS: Of the 277 doctors on the vocational register for psychiatry, 159 responded, giving a response rate of 59.8%. Most psychiatrists were male (n = 102; 64.2%), European (n = 144; 90.6%), aged between 41 and 60 (69.2%), born overseas (n = 90; 56%), had English as their primary language (n = 142; 89.3%) and were in a long-term relationship with dependent children (n = 99; 62.3%). Nearly all (n = 149; 95%) did their psychiatry training in a metropolitan area and most (n = 108; 67.9%) held the Fellowship of the Royal Australian and New Zealand College of Psychiatry (FRANZCP). Most worked in a metropolitan area (n = 136; 85.5%) and either wholly or partly in the public sector (n = 145; 93%). Nearly one-quarter expected to retire over the next decade. Professional factors were rated more important as a reason for staying by metropolitan psychiatrists compared with their non-metropolitan counterparts (p < 0.001). Psychiatrists who did not have an FRANZCP (57%vs. 27%, p = 0.05), those who had spent more than 50% of their professional life in New Zealand (86%vs. 74%, p = 0.02) or those who had obtained their primary medical degree outside New Zealand were more likely to be in non-metropolitan areas (81%vs. 49%, p = 0.04). Metropolitan psychiatrists rated personal and social reasons more highly than non-metropolitan psychiatrists did for factors which might induce them to leave for another area, whereas professional development was ranked lower. CONCLUSIONS: This is the first contemporary study of New Zealand's psychiatric workforce and it highlights some interesting trends and has significant implications for those concerned with the recruitment and retention of psychiatrists. Further investigation is suggested, as a more complete picture of New Zealand's specialist psychiatric workforce would be gained by including psychiatrists who are not vocationally registered.

Adult↗
PubMed1978

Specificity of acquired clonal chromosome abnormalities in New Zealand Black mice.

New Zealand Black (NZB) mice, an inbred strain characterized by immunological dysfunction and lymphoreticular malignancy, also develop populations of aneuploid spleen cells. In detailed cytogenetic analyses performed on 10 NZBs, the chromosomally abnormal cells were found to be clonally related within each mouse. Moreover, the karyotypic changes observed were highly non-random, usually involving the 15 (10/10 mice), 2 (8/10 mice), 16 or 17 (9/10 mice), and sex (6/10 mice) chromosomes. These observations suggest an important relationship between chromosomal alterations and tumorigenesis in NZB mice and emphasize the role of chromosome 15 in murine abnormal lymphoreticular proliferations.

Animals↗
PubMed1988

Quantitative and cytoarchitectural studies of the entorhinal region and the hippocampus of New Zealand black mice.

New Zealand Black (NZB) mice were suggested as an animal model for human dementia. We performed quantitative and cytoarchitectural studies of the entorhinal region and the hippocampus of 10 NZB mice and compared the results with those for a control group of 10 Carworth Farm Webster (CFW) mice. No cytoarchitectural disturbances were observed in the entorhinal cortex and hippocampus of the NZB mice. We, however, found a reduced density of nerve cells in the entorhinal region as well as in the CA1 and CA3 regions of the Ammon's horn in NZB mice. Since the entorhinal region is an important link between sensory and association cortices and the limbic system which seems to play an important role in learning and memory, the present findings may be a cause of learning and/or memory deficits in the NZB mice. The undisturbed cytoachitecture of the entorhinal cortex suggests that the reduced cell sensity in NZB mice is rather an acquired lesion than a developmental malformation and, therefore, indicates therapeutic studies on memory and learning deficits in NZB mice.

Animals↗
PubMed2002

Elevated C-met in thymic dendritic cells of New Zealand Black mice.

New Zealand Black (NZB) mice are a well-known animal model of human autoimmune disease. Although the mechanism for development of autoimmunity is unclear, NZB mice are well known for severe thymic microarchitecture abnormalities. It is thought that thymic dendritic cells (DC) may play a role in thymic education and contribute to the autoimmune process. To address this issue and, in particular, that qualitative and/or quantitative differences exist in thymic DC, we took advantage of a novel restriction analysis system that allow definition of differences in the expression of tyrosine kinases using highly enriched populations of thymic DC from NZB compared to BALB/c and C57BL/6 mice. The method chosen, restriction analysis of gene expression, allowed the determination of protein tyrosine kinase transcription profiles. We report herein that NZB mice have a significant upregulation of C-met compared to the control strains. The abnormality of the C-met transcription was confined to thymic DC. We believe that its abnormal expression reflects the resistance of thymic cells to apoptosis, which will ultimately lead to defects and/or abnormal signaling by the interaction of thymic DC and thymocytes. Further studies involving such interactions are under way.

Animals↗
PubMed2001

Detection and identification of subcutaneous adipose tissue protein related to obesity in New Zealand obese mouse.

New Zealand obese (NZO) mouse, a genetic model of obesity, shows hyperphagia, hyperinsulinemia and leptin resistance. We analyzed subcutaneous adipose tissue proteins in NZO mice with a two-dimensional gel electrophoresis technique followed by protein sequence analysis. NZO mice showed hyperinsulinemia and hyperleptinemia. Abdominal subcutaneous adipose tissue was inspected in NZO and C57BL/6J lean mice. Two-dimensional gel electrophoresis detected 4 spots which were obviously reduced in NZO mice. Those spots were p26, p19, p18 and p15. Internal sequences of the p26 and p15 protein were homologous with those of carbonic anhydrase III, p19 was cytochrome b5, p18 was superoxide dismutase. Serum arachidonic acid level in NZO mice was lower by 80% of C57BL/6J mice. The present study demonstrated the reduction of several enzymes related to lipid metabolism in NZO mice. These data raises the hypothesis that the supposed changes of membrane fluidity caused by altered membrane lipid content may involve central leptin resistance of this model of obesity.

Adipose Tissue↗
PubMedDate not supplied

Neuropsychiatric reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). The New Zealand experience.

The New Zealand Medicines Adverse Reactions Committee has been monitoring reports of adverse drug reactions (ADRs) since 1965. We wished to determine the numbers of voluntary reports of different types of ADR to all nonsteroidal anti-inflammatory drugs (NSAIDs) over a long time period and relate these to age. As the elderly are known to suffer from neuropsychiatric adverse effects of many drugs, we investigated neuropsychiatric reactions to NSAIDs to determine whether these were more commonly reported in the elderly. We counted all reported ADRs suspected to be associated with NSAIDs as well as selected types of ADRs reported from 1970 to 1989. These were divided into 5-year periods and 10-year age groupings. In each consecutive 5-year period there was a progressive increase in the numbers of all ADRs reported for all NSAIDs. This was particularly marked above 50 years of age, but the numbers were reduced above 80 years. Reports for females accounted for about two-thirds of all reactions. Not unexpectedly, alimentary and dermatological ADRs accounted for most reactions and were more common in the group above 50 years. Overall, neuropsychiatric reactions were the third most common ADR type reported. Their numbers increased with age and peaked in the 50 to 59 age group, with a sharp decline after 69 years. This age distribution paralleled that for all ADRs to NSAIDs. Although neuropsychiatric reactions to NSAIDs were reported in all age groups, they were not reported more commonly in the elderly. This study suggests that neuropsychiatric reactions to NSAIDs may be more frequent than is commonly believed.

Adolescent↗
PubMed2005

Aberrant IgM signaling promotes survival of transitional T1 B cells and prevents tolerance induction in lupus-prone New Zealand black mice.

New Zealand Black (NZB) mice develop a lupus-like syndrome. Although the precise immune defects leading to autoantibody production in these mice have not been characterized, they possess a number of immunologic abnormalities suggesting that B cell tolerance may be defective. In the bone marrow, immature self-reactive B cells that have failed to edit their receptors undergo apoptosis as a consequence of Ig receptor engagement. Splenic transitional T1 B cells are recent bone marrow emigrants that retain these signaling properties, ensuring that B cells recognizing self-Ags expressed only in the periphery are deleted from the naive B cell repertoire. In this study we report that this mechanism of tolerance is defective in NZB mice. We show that NZB T1 B cells are resistant to apoptosis after IgM cross-linking in vitro. Although extensive IgM cross-linking usually leads to deletion of T1 B cells, in NZB T1 B cells we found that it prevents mitochondrial membrane damage, inhibits activation of caspase-3, and promotes cell survival. Increased survival of NZB T1 B cells was associated with aberrant up-regulation of Bcl-2 after Ig receptor engagement. We also show that there is a markedly increased proportion of NZB T1 B cells that express elevated levels of Bcl-2 in vivo and provide evidence that up-regulation of Bcl-2 follows encounter with self-Ag in vivo. Thus, we propose that aberrant cell signaling in NZB T1 B cells leads to the survival of autoreactive B cells, which predisposes NZB mice to the development of autoimmunity.

Animals↗