This study compared community-governed nonprofit and for-profit primary care practices in New Zealand to test two hypotheses: (1) nonprofits reduce financial and cultural barriers to access; and (2) nonprofits do not differ from for-profits in equipment, services, service planning, and quality management. Data were obtained from a nationally representative cross-sectional survey of GPs. Practices were categorized by ownership status: private community-governed nonprofit or private for-profit. Community-governed nonprofits charged lower patient fees per visit and employed more Maori and Pacific Island staff, thus reducing financial and cultural barriers to access compared with for-profits. Nonprofits provided a different range of services and were less likely to have specific items of equipment; they were more likely to have written policies on quality management, complaints, and critical events, and to carry out locality service planning and community needs assessments. The findings support the shift to nonprofit community governance occurring in New Zealand and elsewhere.
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References
1.
GriersonM.Consumer participation, social workers and community organisations. Third Sector Rev. 2: 43–55, 1996.
2.
DevereauxP.A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ166: 1399–1406, 2002.
3.
GrayB.The Empirical Literature Comparing For-Profit and Nonprofit Hospitals, Managed Care Organizations, and Nursing Homes: Updating the Institute of Medicine Study. New York Academy of Medicine, New York, 1999. www.cnhc.org.
4.
LefkowitzB.ToddJ.An Overview: Health Centers at the Crossroads. J. Ambulatory Care Manag. 22: 1–12, 1999.
5.
PollockA.NHS and the Health and Social Care Bill: End of Bevan's vision?BMJ327: 982–985, 2003.
6.
PollockA.PlayerS.GoddenS.How private finance is moving primary care into corporate ownership. BMJ322: 960–963, 2001.
7.
RummeryK.ColemanA.Primary health and social services in the UK: Progress towards partnership. Soc. Sci. Med.56: 1773–1782, 2003.
8.
DashP.New providers in UK health care. BMJ328: 340–342, 2004.
9.
NHS Executive. The NHS Plan: A Plan for Investment, a Plan for Reform. Department of Health, London, 2000.
10.
CramptonP.SalmondC.KirkpatrickR.Degrees of Deprivation in New Zealand: An Atlas of Socioeconomic Difference, Ed. 2. David Bateman, Auckland, 2004.
11.
CramptonP.StarfieldB.A case for government ownership of primary care services in New Zealand: Weighing the arguments. Int. J. Health Serv. 34: 709–729, 2004.
12.
BrownM.CramptonP.New Zealand policy strategies concerning the funding of general practitioner care. Health Policy41: 87–104, 1997.
13.
MalcolmL.GP budget holding in New Zealand: Lessons for Britain and elsewhere?BMJ314: 1890–1892, 1997.
14.
KriechbaumA.CramptonP.DowellA.Independent practice associations in New Zealand: A study of governance structures and process. N. Z. Med. J.115: 50–52, 2002.
HeffordM.CramptonP.FoleyJ.Reducing health disparities through primary care reform: The New Zealand experiment. Health Policy, 2005, in press.
17.
CramptonP.DowellA.BowersS.Third sector primary health care in New Zealand. N. Z. Med. J.113: 92–96, 2000.
18.
CramptonP.Utilisation rates in capitated primary care centres serving low income populations. N. Z. Med. J.113: 436–438, 2000.
19.
CramptonP.DowellA.WoodwardA.Third sector primary care for vulnerable populations. Soc. Sci. Med.53: 1491–1502, 2001.
20.
MalcolmL.MaysN.New Zealand's independent practitioner associations: A working model of clinical governance in primary care?BMJ319: 1340–1342, 1999.
21.
LoveT.Continuing change in primary care: Issues for independent practice associations and primary health organisations. In Continuity Amid Chaos—Health Care Management and Delivery in New Zealand, ed. GauldR., pp. 69–82. University of Otago Press, Dunedin, 2003.
22.
MalcolmL.An evaluation of pharmaceutical management and budget holding in Pegasus Medical Group. N. Z. Med. J.112: 162–164, 1999.
23.
SalamonL.AnheierH.Social origins of civil society: Explaining the nonprofit sector cross-nationally. Voluntas: Int. J. Voluntary Nonprofit Org. 9: 213–248, 1998.
24.
WeisbrodB.Towards a theory of the nonprofit sector. In Altruism, Morality and Economic Theory, ed. PhelpsE., Russell Sage, New York, 1975.
25.
AnheierH.SeibelW.The third sector in comparative perspective: Four propositions. In The Third Sector, Comparative Studies of Nonprofit Organizations, ed. AnheierH.SeibelW., Walter de Gruyter, New York, 1990.
26.
KendallJ.KnapM.The Voluntary Sector in the UK. Manchester University Press, Manchester, 1996.
27.
PowellW. (ed.). The Nonprofit Sector: A Research Handbook. Yale University Press, New Haven, 1987.
28.
SchlesingerM.GrayB.BradleyE.Charity and community: The role of nonprofit ownership in a managed care health system. J. Health Polit. Policy Law21: 697–751, 1996.
29.
StarfieldB.Primary Care: Balancing Health Needs, Services, and Technology. Oxford University Press, New York, 1998.
30.
KornE.GraubardB.Epidemiologic studies utilizing surveys: Accounting for the sampling design. Am. J. Public Health81: 1166–1173, 1991.
31.
Research Triangle Institute. SUDAAN User's Manual, Release 8.0. Research Triangle Park, NC, 2002.
32.
LemeshowS.Illustration of analysis taking into account complex survey considerations: The association between wine consumption and dementia in the PAQUID study. Am. J. Epidemiol.148: 298–306, 1998.
33.
D'AgostinoR.Tutorial in biostatistics: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat. Med.17: 2265–2281, 1998.
34.
CramptonP.DavisP.Lay-YeeR.Primary care teams: New Zealand's experience with community-governed non-profit primary care. Health Policy, 2005, in press.
35.
CramptonP.Comparison of private for-profit with private community-governed not-for-profit primary care services in New Zealand. J. Health Serv. Res. Policy9(suppl. 2): 17–22, 2004.
36.
CrawfordM.Systematic review of involving patients in the planning and development of health care. BMJ325: 1263–1265, 2002.
