How is the user base of general practices associated with Open or Closed Books in Aotearoa New Zealand? An analysis of administrative data

Megan Pledger; Maite Irurzun-Lopez; Jacqueline Cumming

doi:10.1071/HC24177

RESEARCH ARTICLE (Open Access)

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How is the user base of general practices associated with Open or Closed Books in Aotearoa New Zealand? An analysis of administrative data

Megan Pledger

¹ ² ^* , Maite Irurzun-Lopez

¹ , Jacqueline Cumming

¹

+ Author Affiliations

- Author Affiliations

¹ Te Hikuwai Rangahau Hauora - Health Services Research Centre, Te Pukenga Wai - Faculty of Education, Health, and Psychological Sciences, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.

² MiNT Consulting, Wellington, New Zealand.

^* Correspondence to: megan.pledger@vuw.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 17(2) 115-122 https://doi.org/10.1071/HC24177

Submitted: 27 November 2024 Accepted: 15 May 2025 Published: 16 June 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

In Aotearoa New Zealand (NZ), general practices are able to close their books, meaning that they do not enrol any new patients at all. This can increase the barriers that people face in accessing health care and may affect different groups disproportionately.

Aim

This study aimed to examine the link between the enrolling status of general practices and the characteristics of the population in areas served by these practices, ie the user base, across New Zealand.

Methods

Regression models, with bootstrapping, were used to explore the relationship between Open and Closed Books general practices and the variables: sex, median age, total count ethnicity, being born in New Zealand, median personal income, the New Zealand Deprivation Index 2023, health status, and the Urban Accessibility Index in the area surrounding the general practices.

Results

Being a Closed Books general practice was more likely when the user base had higher proportions of people born in New Zealand, had lower health status, were Māori or European, were female, and lived in a large or medium urban area. It was less likely when there were higher proportions of males and Asian peoples. After adjusting for Health Districts, only one variable, being born in New Zealand, remained significant.

Discussion

Characteristics of the user base were associated with a general practices’ enrolling status and mediated by location. These findings contribute to a deeper understanding of the inequalities affecting access to primary health care and point to the potential of geographically tailored approaches to minimise disparities and promote healthcare equity.

Keywords: Aotearoa New Zealand, barriers to healthcare access, census 2023, NZDep 2023, primary health care, primary health care attachment, primary health care enrollment, Urban Accessibility Index 2022.

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