New Zealand’s rural hospitals in 2021: findings from an exploratory questionnaire survey

Abstract

Introduction.There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim. To explore rural hospital leader perspectives of the role of rural hospitals. Methods. An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results. Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. 'Rural Hospital' was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about 'range of services' (median 7, IQR 6, 8), 'accessibility' (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and 'local governance and control' were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital's future. Discussion. By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.

Defining catchment boundaries and their populations for Aotearoa New Zealand’s rural hospitals

“…Our results concur with previous findings indicating substantial variation in the size of facilities defined as a 'rural hospital' in Aotearoa New Zealand. 6 Researchers and policymakers may now proceed to more meaningfully quantify variation in the structure and resources of rural hospitals. This may include access to rural hospitals, examinations of their integration within the wider healthcare system, governance models, workforce models, and the relationship between diagnostic services offered and community need.…”

“…[3][4][5] Even within NZ, there is considerable variation in the size, structure and resources of rural hospitals (including access and integration within the wider healthcare system, governance, workforce models and level and range of diagnostic services offered). 6 The working definition of rural hospitals accepted by the Medical Council of New Zealand and the Royal New Zealand College of General Practitioners' Division of Rural Hospital Medicine (DRHMNZ) includes geographical distance from specialist services; acute in-patient bed capacity; 24/7 acute care; and a predominantly generalist workforce. The DRHMNZ list of rural hospitals currently sits at 24.…”

“…2 The extent to which NZ rural hospitals improve access to health care, improve health outcomes and improve health equity for rural communities, particularly for Māori and Pacific peoples, is currently unknown. 6,7 Importantly, there is no standardised description of each rural hospital's catchment boundary and its population characteristics. 6 Internationally, various approaches have been used to define health service catchments, including distance or travel time measures, and mapping utilisation patterns.…”

“…6,7 Importantly, there is no standardised description of each rural hospital's catchment boundary and its population characteristics. 6 Internationally, various approaches have been used to define health service catchments, including distance or travel time measures, and mapping utilisation patterns. 8,9 In NZ, general practice catchments have been developed using patient enrolment records; 10 however, this approach may not be directly transferable to the development of rural hospital catchments.…”

New Zealand’s health system reforms: an uncertain road paved with good intentions?

“…Blattner and colleagues surveyed rural hospital leaders on their perspectives of the place and contribution of rural hospitals in the NZ health system. 8 In short, rural hospitals do not fit neatly into the new Tier 1 (home and community services) nor Tier 2 (hospital, specialist and diagnostic services) categories of NZ health service provision. 9 Walker and colleagues, in their scoping review of the rural allied health workforce, 10 note the paucity of evidence to inform policy makers on how to improve health outcomes for rural populations.…”