Primary health care funding for children under six years of age in New Zealand: why is this so hard?

The intention of this viewpoint article is to prompt discussion and debate about primary health care funding for children under the age of six. While New Zealand offers a superb natural environment for childhood, our child health outcomes continue to be poor, ranking lowest amongst 29 countries in a recent report by the Organisation for Economic Co-operation and Development. Since 1996, various funding arrangements have been introduced with the goal of achieving free primary health care for children under six years of age and nearly 80% of practices now offer care to this group without charge. Universal no cost or very low cost access for young children, however, remains elusive, particularly for after-hours care, and this is important given that at least one in five children lives in poverty. We are under no illusions about the complexity of primary care funding mechanisms and the challenges of supporting financially-sustainable systems of after-hours care. Good health care early in life, however, is a significant factor in producing a healthier and more productive adult population and improving access to primary care lessens the impact of childhood illness. We suggest that reducing cost barriers to primary care access for young children should remain an important target, and recent examples show that further reductions in cost for primary care visits for young children, including after-hours, is possible. Further funding is needed to make this widespread, in conjunction with innovative arrangements between funding authorities, primary care providers, and emergency departments. We encourage further debate on this topic with a view to resolving the question of whether the goal of free child health care for young children in New Zealand can be realised.