Population - Ministry of Health [PDF]

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I I }TAC?oP~lation based fundi~g. of

I Regional Health Authorities

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for~he

purchase of core personal health services

Health Reforms Directorate November 1992

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T able of contents

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Introduction

1 1 1

Aim' Scope of formula Core services Approach

2

Domicile Projections Age/gender groups

3 3 3 5

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Populations

Costs by age and gender Personal health care benefits Secondary personal health care

.Special Health Needs factor Option 1: CSC/HEQ Option 2: CSC/SMR Option 3: CSC/ENF

11 11 11 12

12

The fonnula calculated

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11'1 IN

vt

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vt

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Age group

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vt GO

9

Population structure - males

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85+

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75-84

65·74

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lo..

II Southern

45·64

mCentral 25-44

OIl

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15·24

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Midland

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Northern

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10. Robustness

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X

X

X

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Measures should not unduly be affected by small changes and errors in the inputs

11. Integration The fonnula should be consistent with the intention to integrate primary and secondary care.

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RURAL/URBAN POPULATION DISTRIBUTION Introduction The question of differences in the distribution of the population throughout the regions and the implications of this for funding needs was addressed by the Special Health Needs Working Party in 1989. They concluded that: "There is insufficient evidence at this stage to include a population distribution factor in the formula. Further research should be undertaken to ascertain the marginal cost differences in running health services in remote areas and to examine the special health needs related to population density. If

As far as we have been able to ascertain, no further research has been undertaken to date in either of these areas. We nevertheless considered it necessary to review this issue because a number of relevant factors will change in the new environment. These include:

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The shift from 14 area health boards to 4 regional health authorities.

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The incorporation of funding for primary health services in the population funding formula .

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The requirement that RHAs provide a specified set of core health services.

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While an increase in the size of the regions is likely to reduce any regional differences and therefore support the conclusion of the previous review, the other: two factors are more likely have the opposite effect. Primary health services are likely to be more susceptible to differences in the cost of provision because equality of access requires that these services, more than secondary services, are provided close to where people live. And the identification of core services centrally effectively requires RHAs to ensure that all of their population has adequate access to certain services, regardless of the cost of provision. Thus without further work it seemed inappropriate for us to conclude that no factor for popUlation distribution is necessary in the formula.

Differences in population distribution To examine whether or not there are any real differences in regional population distributions, census data were analysed in two ways. First, the population of each RHA was broken down into 4 urban/rural categories (Figure 1). Second, the density/sparsity of the RHA population as measured by hectares per person was broken down by census area units. The analyses both

•

show that, overall, New Zealand is highly urbanised with 50% or more of the populations of all four RHAs living in a main urban area. All 4 RHAs also have at least 8% of their population in secondary or minor urban areas, and 10% in rural areas. There are nevertheless real differences in the remaining third of the population, with the Midland RHA being the most rural of the four, and tile Northern RHA the most urbanised.

Urban/rural distribution of RHAs' populations.

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75 to 84 75 to 84 85 +

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196 143

429 340 250 211

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97

87

222

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262

151

254

384

630

602

1,011

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5 Discussion

The estimates here are not highly accurate for the following reasons.

Problems with

esc 2

The largest posoe is pharmaceutical, and a major data source was the pharmaceutical costing model. This does not report accurately on ese 2 usage and costs. There are two reasons for this. First, the model uses estimates from TaxMod of the number of people eligible for ese 2 cards. The small proportion of the

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population eligible for esc 2 status mean there are sampling proble!11s in estimating these numbers. Second, apparently a substantial (but unknown) proportion of eligibles have not taken up cards. Inaccuracy does not affect the forecasts materially, and is unlikely to affect PBF allocations to RHAs. However, there could be public relations problems in using in a funding formula the esc 2 per head costs we have derived.

Assignment of CSC across the three elderly age bands

We had no information on health service usage by both esc and elderly age bands (65-74, 75-84, 85 +) simultaneously. We therefore used population data to allocate eses across these age bands and gender groups. This is likely to bias the results because it is probable that old elderly people are more likely to be in esc 1 than younger elderly people. This is because the younger elderly are more likely to be in paid employment, and investment incomes are ··probably higher. Also, elderly women may tend to be poorer than elderly men, and so more likely to be in esc 1.

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Absence of information on usage by CSC for untargeted benefits

Only two of the benefit areas in the study are esc-targeted (GMS and pharmaceuticals). Age-specific per head usage for the services subsidised by these benefits is higher for ese 1 than ese 3. This could be solely because user charges are lower, or because of both that and higher need for heath services. We had no data on usage by esc for services not targeted by esc. We may therefore have biased our expenditure results against esc 1.

National populations by gender, age and CSC

TaxMod is based on the Department of Statistics Household Expenditure and Income Survey. This survey does not have a large enough sample to obtain data on national populations by detailed age groups, gender and esc. The nature of the bias introduced by lack of appropriate population estimates is unknown.

Conclusions

Some improvements in the accuracy of our estimates may be achievable through the following:

• More recent Tilyard data which has information on

GMS

visits (and possibly

prescription usage) by gender, detailed age, and esc.

• Analysis of 1991 census data to get a more accurate estimate of popUlations by age, gender and esc. Given the small size of benefit expenditure in relation to total extra effort may not be worthwhile.

RHA

expenditure, the

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[COSTS.XLW)Module 1

1.10.1992.

-. rODULE ONE: Data Collection and Manipulation The format of this model is as follows:

~BOC expenditure 1991192 by benefit areas (named expenditure):

# Pharmaceutical benefits # GMS fees and MYA 'Ii Maternity and domiciliary midwifes: fee and MYA # Practice nurses and health centres # Schedule B and dental nurses # Geriatric OPB

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fOPulatiOn data for New Zealand 1992 (named population): (i) Estimated population by age and gender (ii) Estimated population by esc and age

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~er data and manipulations to obtain allocator proportions (named allocator)

I . 1POBOC expenditure 1991/92 by benefit areas 1jf following table summarises POBOC expenditure in the six benefit areas r.1991192.

Expenditure ($thous)

. Benefit areas

Name ofrange containing value

Lceutical benefits

556,372

Subybanna

Is

166.584

SubJIllS

fees and MY A

Maternity and domiciliary midwifes: fees and MYA

67.250

ltice nurses and health centres

29,369 l7,669

. tedule B and dentaJ benefits Geriatric DPB

54,10 I

Iree:

The table above was supplied by the Corporate Finance Group, Department of Health (Marc Warner - Manager of financial accounting)

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Sub_maternity

Page 1

SubJeriatric

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2. Population Data for New Zealand (1992): 2.1: Estimated population by age and gender

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Two sets of population data. by age and gender. are illustrated below. The first (table 2.1a) is data obtained from the Department of Statistics Key statistics publication for July 1992. The second table (2.1 b) expresses population numbers by PBF age bands. Table 2.1.

data as at 31 March 1992 (provisional)

Po~ulation

A e bands under 5 5 t09 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 10 to 74 75 to 19 80 and>

males 148240 130900 129990 142460 143560 133100 140950 123800 117810 96860 85670 70430 71450 62500 45850 32770 27690 1704030

emales 138890 124450 125560 138880 141280 138300 146020 129180 118650 96080 85810 69390 70410 68450 58940 46260 54350 1750900

total 281130 255350

255550

281340

284840

211400

286910

252980

236460

192940

171480

139820

141860

130950

104190

19030

82040

3454930

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S9urce: Key statistics July 1992, pl9, table 2.04

Table 2.1b Po~ulation

data in PBF a~e bands Gender Total

Age Female population

Male btJnds

300

>500

Northern

0.998

0.998

Midland

1.051

1.051

Central

0.993

0.993

Southern

0.964

0.964

Table 20: Sensitivity of SHN factor to area unit popUlation minimum based on HEQ

>300

>500

Northern

0.99

0.99

Midland

1.06

1.059

Central

0.99

0:99

Southern

0.971

0.972

The differences in Tables 19 and 20 are generally less than 0.00 1. 20

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Another sensitivity check is based on quantifying the effect of variability in admission rates. See the plots of admission rate versus domicile population in Appendix M. The regressions presented in previous sections account for only a small amount of variation. We now consider what happens if the entire calibration is based on much larger domiciles to reduce the variability. Our analysis is confined to HEQa calibrations .

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The first step is to "neighbourhoodise" domiciles by ranking them according to HEQa and merging domiciles with similar HEQa scores to give neighbourhoods of approximately the same size: Somewhat arbitrarily we aimed for neighbourhoods of (it least 20,000 persons. The merging produced 150 neighbourhoods of about 22,400 persons. ~ .

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U sing the population weighted HEQa to define the HEQ score we plot the neighbourhood admission rate vs the HEQ score as in Appendix M. The ANOYA table of Appendix Freveals that the straight line coefficients obtained are in agreement with those obtained previously. Moreover, as is to be expected, the proportion of variance explained is significantly greater (28% compared with 8%). Finally/as a check on the effect of using only one or two years, we give the ANOYA table for a admission rates on HEQa in Appendi~ q. Evidently the straight line coefficients are in agreement with those obtained using both 1990 and 1991 admission rates.

regress~on of 1991

4

(3ionclusion

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The analyses presented here have shown the first principal component to be a reasonably robust statistic over time and also to small changes in variable selection.

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Although there are urban to rural differences in the correlation structure of the original 11 variables,

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a subset of these variables does not demonstrate this differentiation to the same yet still captures ... ,. the main features of original variables. The low percentage variance explained by the calibration regressions is a cause for concern since we would have expected a higher correlation on the basis of previous work in [8]. Standardisation using the appropriate age/sex groups might improve the, correlations but we feel effort would be better spent investigating reasons for the high variability in "raw" admission rates.

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References

[1] Appendix 2 of 4:Special Health Needs, Working party reports on population based funding for area health boards, Department of Health, 1989. [2] Reinken, J., M~Leod, J.W. and Murphy. T.LD. Health and equity. Department of Health special report 72, Government Print, Wellington, 1985. [3] Reinken, J. Measures of social need for resource allocation. Appendix 1, Special Health

Needs:working party reports on population based funding for area health boards. Department of Health, Wellington, 1989. [4] Hoskins, R.S. Social equity and morbidity, A report to the working group on special health needs population based funding formula review, Department of Health, 1989. [5] Hoskins, R.S. Population based funding, social equity and morbidity. New Zealand Medical Journal, December 1990. [6] Morris, I.A. and Gardner, M. I. Calculating confidence intervals for relative risks and standardised rates. BMJ, voL 296, May 1988.

(od~s

ratios)

[7] Krouse, D.P., Rhoades, D.A and Donnell, D.J. The relationship between standardised hospital admissions and "social need" scores derived from census variables. DSIR Physical Sciences DSIRPS-C-22. Prepared for Department of Health, February 1991. [8] Krouse, D.P., Rhoades, D.A. Alternatives for the calculation of special health needs factors, DSIR Physical Sciences DSIRPS-C-24. Prepared for Department of Health, March 1991.

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HEQa (population > 300) Residual Standard Error 6.3717, Multiple R-Square = 0.0844 N 934, F-statistic = 85.8789 on 1 and 932 df, p-value = 0

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coef std.err

-1

a 0.1460 b 0.0183

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ANOVA for admission rate regressions

t.stat p.value

o

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0.0035 41.6971 0.0020 9.2671

HEQ (population> 300) Residual Standard Error = 6.3464, Multiple R-Square = 0.0916 N 931, F-statistic = 94.0193 on 1 and 932 df, p-value = 0 coef std. err t.stat a 0.1460 0.0035 41.8820 b 0.0201 0.0021 9.6964

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HEQa (population> 300) Residual Standard Error = 5.9904, Multiple R-Square = 0.0611 N 934, F-statistic 60.6519 on 1 and 932 df, p-value 0

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ANOVA for DRG cost weighted admission rate regressions

coef std.err t.stat p.value

a 0.1351 0.0033 41.0572 0

b 0.0145 0.0019 7.7879 '0

HEQ (population> 300) 23

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I Residual Standard Error 5.9731, Multiple R-Square = 0.0665 N 934, F-statistic 66.4087 on 1 and 932 df, p-value = 0 coef std.err t.stat p.value a 0.1351 0.0033 41.1955 0

0

b 0.0159 0.0019 8.1492

CANOVA for under 65 death rate regressions HEQa (population> 300) Residual Standard Error = 0.0432, Multiple R-Square = 0.2868 N = 934, F-statistic = 374.7499 on 1 and 932 df, p-value = 0 coef std.err t.stat p.value a 0.0023 0 94.8398 0 b 0.0003 o 19.3585 o

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HEQ (population> 300) Residual Standard Error 0.0429, Multiple R-Square 0.2982 N = 934, F-statistic = 395.9535 on 1 and 932 df, p-value = 0 coef std. err t.stat p.value a 0.0022 o 95.6036 o

b 0.0003 o 19.8986 o

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Sensitivity to "outliers"

:1 The following ANOVA table corresponds to the regression of admission rate on HEQa excluding rates less than 0.03 and those greater than 0.5. 24

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Residual Standard Error = 3.8781, Multiple R-Square 0.1879 N 838, F-statistic ,193.371 on 1 and 836 df, p-value 0 coef std.err t.stat p.value a 0.1576 0.0023 68.4577 a b 0.0187 0.0013 13.9058 0

E

Sensitivity of SHN factors to area unit population nlinimunl

The following ANOVA tables are based on admission rates.

HEQa (population > 500) Residual Standard Error = 6.3839, Multiple R-Square = 0.0844 N = 893, F-statistic-= 82.1785 on 1 and 891 df, p-va1ue = 0 coef std. err t.stat p.value

a 0.1455 0.0035 41.3633 a

b 0.0180 0.0020 9.0652 0

HEQ (population> SaO) Residual Standard Error 6.3544, Multiple R-Square = 0.0929 N 893, F-statistic = 91.2493 on 1 and 891 df, p-value = 0 coef std.err t.stat p.value a 0.1455 0.0035 41.5907 0 b 0.0199 0.0021 9.5524 0

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Sensitivity to merging of domiciles

The following ANOYA table is for the regression of admission rate on population weighted HEQa for 150 "neighbourhoods".

Residual Standard Error 0.0518, Multiple R-Square 0.2769 N 150, F-statistic = 56.6786 on 1 and 148 df, p-value 0 coef std.err t.stat p.value

a 0.1464 0.0042 34.4532 0

0

b 0.0178 0.0024 7.5285

G

Sensitivity to number of years of data

The following ANOYA table is for the regression of 1991 admission rates on HEQa.

Residual Standard Error 6.6706, Multiple R-Square = 0.0827 N = 934, F-statistic = 84.0534 on 1 and 932 df, p-value = 0 coef std. err t.stat p.value a 0.1485 0.0037 40.5226 0 0 b 0.0190 0.0021 9.1681

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All CA U correlations and rural CAU correlations

The correlations are based on CAUs with more than 300 persons (there are 1520 such CAUs).

1

2

3

AllCAUs 456

7

8

9

10

11

1

PMAORI

1.00

0.15

0.32

0.46

0.63

0.68

0.32

-0.42

-0.27

-D. 15

-0.47

2

PISL

0.15

1.00

0.2t

0.15

0.40

0.20

0.42

-D.31

-D.35

-D.14

-D.16

3

PSEPDIV

0.32

0.21

1.00

0.18

0.63

0.27

0.59

-D.61

-D.28

0.41

-0.29

4

PNOTERT

0.46

0.15

0.18

1.00

0.36

0.51

0.24

-D.37

-D.17

-0.02

-0.77

5

PSEEKRS

0.63

0.40

0.63

0.36

1.00

0.68

0.60

-D. 60

-D.35

0.08

-0.50

6

PBENEFS

0.68

0.20

0.27

0.51

0.68

1.00

0.26

-0.32

-D.30

-D.25

-D.64

7

PNOCAR

0.32

0.42

0.59

0.24

0.60

0.26

1.00

-D.85

-D.55

0.60

-D.36

8

PTWOCAR

-0.42

-D.31

-0.61

-0.37

-D.6O

-D.32

-D.85

1.00

0.50

-D.59

0.51

9

POWNED

-D.27

-0.35

-0.28

-D.17

-D.35

-D.30

-D.55

0.50

1.00

-D.26

0.26

10

ro~P

-0.15

-0.14

0.41

-0.02

0.08

-D.25

0.60

-D.59

-0.26

1.00

-D.1O

11

INCO?\.1E

-D.47

-D.16

-0.29

-0.77

-D.50

-0.64

-D.36

0.51

0.26

-D.1O

1.00

6

7

8

9

10

11

Rural correlations

1

2

3

Rural CAUs 4 5

1

PMAORI

1.00

0.20

0.36

0.33

0.72

0.74

0.69

-0.59

-D.30

0.04

-0.48

2

PISL

0.20

1.00

0.21

-D.Ot

0.17

0.07

0.15

-D.l8

-D. 11

-0.04

0.02

3

PSEPDIV

0.36

0.21

1.00

-0.04

0.58

0.33

0.49

-D.55

. 0.06

0.46

-D.42

4

PNOTERT

0.33

-0.01

-0.04

1.00

0.23

0.34

0.35

-0.38

-0.15

0.16

-0.39

5

PSEEKRS

0.72

0.17

0.58

0.23

1.00

0.73

0.61

-0.58

-D.05

0.17

-0.54

6

PBENEFS

0.74

0.07

0.33

0.34

0.73

1.00

0.51

-D.43

-D.23

-0.01

-0.53

7

PNOCAR

0.69

0.15

0.49

0.35

0.61

0.51

1.00

-0.81

-0.09

0.53

-0.59

8

PTWOCAR

-0.59

-0.18

-0.55

-0.38

-0.58

-0.43

-0.81

1.00

0.24

-0.62

0.67

9

POWNED

-0.30

-0.11

0.06

-0.15

-0.05

-0.23

-0.09

0.24

1.00

0.06

-0.06

0.04

-0.04

0.46

0.16

0.17

-0.01

0.53

-0.62

0.06

1.00

-0.50

-0.48

0.02

-0.42

-0.39

-0.54

-0.53

-D.59

0.67

-D.06

-D.50

1.00

10

PONEP

11

INCO?\.1E

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GlenJnnes Tatna~ ­ Otahuhu_We

:r:

m

1-----,

GlenJnnes _ _ _...I PoinCEngl - - - . . . ;

I

Win - - - - - '

[ o

4

2

6

8

"

f

10

'\:~'

,~~===~=f---1---..,

Queenwoed ChatlWell Riverlea

Hillcrest

Pukete -=:---l--_--.J Dinsdale N ------, Glenview Chedworth Matangi Tamai1er&-T Whatawhata Ngahinapou

Kaipaki ----L1

Eureka - - - - '

Lake Carner Rautapu

Rototuna - - - " ' " \

Te Pahu - - - - - ' - Te Rore - - -...... Wawa---....., Pukerimu Kainui Gordon\on ---~



:===}--_.....J ::===}--_.J

Acacia Bay' ---~_ __

Waipahitii

Te Kowhai - - - - ,

Beerescour - - - - - '

Pauanui_Be . - - - - ' TeR~u:====J-____1 lurua LakeK"ar.apiro

Ngaro 1----., Rotoorangt :"---"""'1-_

Hinuera - - - - '

====1-,

Ngarua_=====~J

Whiti~u

===::J--.1

~~01~~~~~~--l

Marotiri

Waipa Vall



===::J---.J

----,

Paraonui _ _ _....J 1-_ _ _ _---,

Hamilton L i~~~=~=~ DalesIoI'd Pirongia'

~~;=:=~:J

Leamjngl~O~n~=;=J Leamington

Te Awamutu

Te Awamutu -;;;;;;~_ _ Nukuhau

Pukete Was - - - " " " ' 1 - _

Fairview D - - - - '

Richl'l'lOiid H ---.......,

.J

-

NawtOn - - -.....

Melville - - - - '

Te Uku - - - - c .__

Glen_~sa

C C

ge_

==-:::-1-___-,

Moanataiar

Matamata

Morrinsvil - - - - ,

=

====:1---,

-

c..v

0

0 ""C

CD -,:

0

:::J

(f)

0-,: Q..

CD -,: CD

Q..

Tirauu===;:::=Te Awamutu Te:Awamutu Te Puru-Th _ _ _-,

Trurua ---....,

Whanqarnata Wnltian!lb"omandel - - _..... Rere~ Hikuai

:::J

Te- Aroha ~:;;;h~~--..,

Te Kauwhat

f'arawai - - - . ,

Te

0-,: CD

CJ)

lIIgatea

Dinsdale S

(f)

::r

l~::~w~ru;'to=a~======}-_ _~

Cambridge

Ohaupo

'i

Ol

Ngurunui Otangiwai­

Hilltop Bryant

r-+

-+­

Mararriaruaa .::==~..J_

~~~ ~angatira

;;'J';"

3

HOratiu Arapuni Te

Oruanui

Waerenaa -

ROtOtlgUuh-i-ih-j=:::~=:::::-, Te Akau

Marokopa ~-==::J---..J

1

-+­

T~uroa

Hauraki PI ---oJ LiChfield - - - . , Tapapa Qmk;;;au~i;a-=~-.-J Pokuru - - - - ,

f ~ f

Ol I} Ol 0 0 I: » c I

~ ::r I:

====)-----l-----,

"Raglan Waihi ;;;=:==~~~ Piopio Com

Ke~pehi -;-==::~:----l MiIhoenui Putaruru - - - " ' " \ Otorohanga HuntjLE"as -===~ Paeroa - - -.... Te Kuiti ~ Taumiiunui ___--'

Kawhia_Com

====)-___

IT

'<

:r: m

0

Ol

I; lit., I I

1 ;1

:1 ~I

;:1 :1

~I \,

J

---I

o

---I

---I

Te_Rapa

6

4

2

8

----,If----------:--------,

Wairakei-A ------'I

J Raurimu -----,1

-I

-I

University Maeroa

--~

Porrin - - - ' I CentraJ_Ta

---I



r

------'

Clarkin - - - ,

--I

--I

Enderley - - - - - ' Claude land - - - - , Naylor

---'h I

Peachgrove - - - - - '

I--

Hamilton_E

1

1

I

_~I

r-+

:::r

Ohura - - - - - - ' Tokanui - - - - ,

CD Tauhara - - - - - ,

r-+

lwitahi - - - - '

Pl

:::r

:::J

Manunui - - - - - - '

c.u o o ­

_Kihikihi - - - ,

11---_---,

T~upiri-9o

I~

1

----'

"'"0

.., en o

CD

Bader

1 I 1 I

Swarbrick

Tarratl90we - - ­ Sunshine-H - - - - '

:::J

en o..,

J

Turangi _ _ _

I--

Ngaruawahi - - - - - - '

Kuratau Meremere_C - - - - - ,

Q..

----,1

I

CD .., CD

11------'

Q..

InsoU - - - - - - ' Waharoa Mangakino

---'I

-----,1

I

Jf-------'

Huntly_Wes - - - - ' Aetea - - - - - ,

-----,~I-------­

Strathmore Parkdale - - - - - - '

Matarawa - - - - - - '

I

1

:3 o ..,

Stanley _Pa -----,1

Tokoroa Ce - - ­

~-----------'

IT

'< I

m

oPl

r;

o

5

10

I~

15

, .:j Omokoroa C - - - . . . , 1-------, Matua------,

Maungatl!4'u - - - - '

Otumoetai

1\ 'f

Lynmore ====]-----1 Spring tiel

Pomare ---....,

Sunnybrook - - - . . . ,

Kawaha Poi - - - - '

COasdands - - - . . . . . I

Hamurana - - - . . ,

Tarawera - - - - '

Waiwhero - - - - '

OJ

OJ '< 0

I; I: '< 0 1 » c 1 ~

Ohope - - - - - '

---t-\

Ngakuru - - - . . . ,

Otakiri - - - - '

Golden Spr

Minden

-

==-.r-i

-0

Kaimai - - - - ' Te Puna - - - - - ' Upper_Papa - - - . . . , 1-_ _ _-' Aongatete - - - - '

Bethlehem - - - - - ,

Ohauiti·Ng - - - - '

CD

:::l

..-+

Otumoetai ====]-_ _ _1 GlenholmeTauranga C Tauranga_S ----...,

1-----,

Tauranga_H _ _ _--I Mt_Maungan - - - - - '

Omanu----.

(j)

Allandale- - - - - - - '

Pukehangi

Te Maunga ------.

Brookfield - - - - '

Island Vie - - - - ,

Athenree _ _ _..J

Te Puke Co - - - . . . ,

'Ratikaii

..-+

:::r

..r--,

c ___

Waifil Beac - - - . . , Greerwn _ _ _--I-

3

Judea - - - . . . ,

Arataki - - - . . . ,

Whakatane_----r­

Reporoa ---....,

Welcome Sa ---...,

~

Bellewe _ _ _- - I ,

Hairini - - -....

Te Reb---....J

Te Puke -Co - - -.....

1:a5 ___..J

Hillcrest Rotoma - - - - . Pongakawa

0 0 -0 CD

Waiolahi _ _ _--f

Tikitere - - - . . . I ~~!aha===~____~~__~ Paengaroa Matahina-M _ _ _..J

Papamoa_Be - - -....

~

Gale Pa - - - - ' Mangakakah - - - - , Ngon~!aha _ _ _..J

(j)

---...I

0

::::J

Papamoa Be - - - . . ,

POlke - - - - '

Owhata Wes - - - - '

(j)

Kawerau ---...,

0 ~ 0.. CD ~ CD 0.. CJ

Selwyn Hoi - - - - . Fairy_ Spri

\--__....J

Weslern He - - - . . . ,

Pukehangi_

---...I

T!ident ---....,

Yatton Par ---....,

Maketu Matata

com ---...,

cOm ---..., r

Tamatea_So - - - ­ Bay-View - - - - - , Haumoana ---~

Tamatea_No _ _ _...J

r-t-

Awatolo - - - -

Shereoden- - - - . . . ,

Tikokino

1----...,

Elslhorpe- - - - - '

Tangoio - - - . ,

Whanawhana - - - ­

Maraekalonville_W

Waio~hu :::===}-_________- , MasseLUn; Waiouru : : : = = = J - - - - - - - - - - - - - - - - - - , Unton_MiI

Le:=in~So::ut:J=H=i~9h=bu==ry}------:.-:.~~~---~ -

Shannon Masslon

c.u

a a

I

I

I

-a CD

.....

en a ::::J en

o.....

Cl. CD .....

CD Cl.

rr

'<

I

m

I o

p.) ww

Palmerslon - - - - '

Ralana Com ====}-___________.-J 8algiiwnje

I

"".

·1

o

I

1

.1

I

2

4

6

Endeavour - - - - ,

Discollery

Papakowhai - - -....

Tawa South - - - ,

Greenacres - - -.....

Heretaunga - - - ,

Wobum Nor - - _.....

Churton Pa -

Norrnandale -

Belmont - - - - '

Parernata·P - - - - ,

Kelson - - -.....

Maungaraki - - _.....

Pauatahanu - - - ,

Pencarrow _ _ _....J Makara-Oha - - -....

::J

CO r-+

Mangaroa

~ Pinehallen Manuka -

/-_ _ _ _..J

Te Marua - Opaki --~

Adventure - - - - ,

T awhal - - - ,

Towa Par - - - - '

Emerald Hi - - -.....

-Hornebush·T - - - - ,

o

::J

o

»

c

-===::J----i ::::===1-_,

Kopuaranga Te Wharau ­ - Mt Holdswo - - - , -Kahuwa ---~

en



~

Mana-Cambo Korokoro Pukerua Ba _ _ _...J

Grenada Newlands S - - - ,

Newiands::::N - - -.....

Seatoun - - - - ,

Heretaunga - - _......

r-+

----1-__...1

::r

:3

o

JohnsooviJ JOhnsoovil -===:::J---~ -

-,:

==::J-i

Happy_Vall Melrose

Kingston - - - ,

Karon Par _ _ _...J Rarea----, Island_Bay - - - - - . ISland_B.ay _ _ _....I Moonshine - - - - ,

CD r-+

::r

OJ

-===::J------I

.1

I

.1

_I

::J

Central Ta .. Unden -

Paraparaum - - - - ,

Cloustoo P - - _.....

Eiderslea - - -......

Gre~n:====J-_ _ _~ Lansdowne

Khandallah - - - ,

Te_Kainga - - - ,

Awarua _ _ _...J

Wadestown - - - ,

UJ

o

o

-0 CD -,:

::::===I-_....J K~burn -===::J---------------J

en

Karon Eas Johnston H

o

::J

TaltviUa -

Karaka_Bay - - - - ,

Eastboume _ _ _....J Rangoon_He ---~

Wright_Hil - - - - ,

Plimmerton - - -.....

en

o -,:

a...

Wilton-Ota - - - ,

Ngaio - - _.....

Vogeltown - - _.....

Hataitai - - - - ,

Northland - - _.....

Brooklyn - - _.....

Hun Cantr - - - - ,

WaikaOae E - - _.....

Waikanae_C _ _ _....I

CD -,: CD

a...

rr

-===:::::J-----i

'< I

Waikanae B -

RaurnatiJ3e Paraparaurn - - _.....

Boulcon·A

Waterloo - - -....

Miramar No - - - ,

Miramar-So - - _....

Johnsoovil Epuni_West

m

:::===}----"l---~

-===::J-------------l -===:::::J---,___.. .,

Ebdentown - - _.....

Oriental 8 Thomdon:r

Mitchellto - - - . . . ,

Kilbtrnie Mt Vi CIon ­ Ad~aide - - - ­ Woburn_Sou - - _.....

~----------~

oOJ

o

6

4

2

8

10

Cloustonvi ---....,

Maungakotu - - - ­

Olaihanga - - - - ,

Raumati_So - - - ­

Ranui_Haig - - - - ,

Maupuia - - - ­ Haywards-M _ _ _....J

Akalarawa - - - . . . , Pat1

Shir!ey_Ea - - - - ,

Northoote Sockbum -

:::J W

I

-----'I

Barringlon Somerfield - - - - ,

Rawhili - - - - - ' Culverden ---'""I

-===}-___ -===)-_____1tJI

Cheviot Waimataita ­

Oiamond_Ha -----.f­ Akaroa - - - - '

Highfield Barrington ­

--===}--i

Sumner - - - ,

Opawa----.. Papanui

---...I

Central_As

----.1

--===}-____ Fairlie_Co

Rakaia Amberley ­ Geraldine - - - - , Hampstead - - - . . . ,

----"L-

JI -

I

Waimate - - - - - ' Central_As - - - - - - '

-===J----------lI -==:=J---, I

Horn~_Sou Horn~_Nor -

Netherby Kaikoura -

1-_ _ _-'

Temuka _ _--'J

MOOvale---~------__---------------~

51 Albans

-0

CD

--c

en

a

:::J

en a

I

51_Marlins Aorangi-

o o

I

I

I

.1

a.

CD --c

CD

Q.

c­

'<

I

m

o

PJ

:1

~I

.1

o

.1

6

4

2

8

10

Templelon

Hillmorton

oOJ

Casebrook - - ­

:::J

-+­

I

CD -,;

Wooiston_W - - ­

cr

c-,;

Broomfield Bexley

'<

o

Bromley - - - - - '

.1

»

Pines·Kalr

Wharenui

c(J)

J

Pareora

jlimaru_Gar

I

I

I

.1

I

~I

.1

-+­

:::r

}

Riccarton

3 o-,;

r-----,

SpreydOn

J

Avonside

CD

r-

New_Bright

---,

I

-

Parks ide

Seaview

-+­

:::r

OJ :::J

­

Middleton

Nom:,.'Linw

VJ

o

I

S

o

""0 CD

Ensor s

-,;

.lellie_Par

(J)

o

Twizel_Com

:::J

SeAIbans_

(J)

Edgeware

South_Rich

o-,;

J

Sydenham

Q.

CD -,; CD

I

J

Linwood

Q.

Riccanon_ Add inglon W allham

Phillipsto

cr

:=J--

'<

I

m

o OJ

Ferrymead

J

Aranui

Hagley]ar Calhedral_

I

J

I

_~.

J------,

t---­

I

J

,~, ~:-

o

4

2

6

6

10

f.

12

-)

Bums Pain - - -..... Helensburg Glenleith - - - - ' Macandrew

----..,J----h1-----..

___ -=====:::1----, ====:J---l

St Leonard ---..... funer Peni =======~ Broad::Bay-

11

I1

~

­

Maori_Hill - - - . . ,

Andersons

(,

Belleknowe -

Roslyn_Sou Roslyn_Nor

0

Opoho - - -....

r-+

Omarama ====~f----.-J

Wanaka ---...,

Otemalata - - - - '

East Taier ---'~ Fairfield - - - - '

Wingarui f----...,

Momona

Stirling ~ Ardgowan ----.~

OJ

(Q

a

l

Outram - - - . . . ,



Maheno - - - - - , Bruce

Walhemo ----..., Maniototo - - - - '

L

I

r-+

::y

f------,~

-

===:::1-----..J

St Clair - - - - '

===J-----,

CD

===1---,

~

(j)

1 f-----, )-----,

0

Ranfurly - - - - '

:J

en

W

­

0 0.. CD CD 0.. ~

Orana_Park------,l---J Palmerston - - - - '

~

Wakari==--~----.

Oamaru_Cen - - - - , St Kilda_E - - - - '

=====f---,

1

1-_ _ _ _ _-'

- Caversham Forbury 51 Kilda C - - - - '

- Cromwe41 - - - - ,

-­

rr

'<

Tapanui====--~--Jr---..., Milton - - - - ' '---

:r: m 0

Lawrence - - - - - ,

~~;;~~==}-

KaitatlQata Owaka

Hampden

Concord Halfway Bu

CorntorPhi

___J

===:::1-------, :::=====J---l ­ __ =====f------------.J

Dalmore

Brockville - - - - '

OJ

~I-----------------'

Taiaroa-Ca Clinton

I

Botan~ Ga ====J--------------------------~I

Otago_Dniv

:J

0 0 '"0

Brighton - - - - ,

Bush Road ----'1

Alexandra - - - - , 1---..., Waikouaio '­ Oamaru Sou _ _ _...J~ BJdutha - - - - ' Green Isla - - - - , Mosgiel:'Ea - - - - ' Oamaru Nor ~

OJ

w

Wairati - - - ,

Karilane - - - - - - ,

Warrington _____..I' Ravensbour I------.

Forrester

MosgieCSo Roxburgh

I:

CD

----ul---'I

Clyde Hawea Kurow

r-+

~

Balmacewen - - - ,

Port Chalm - - - - '

I"

:3 a

Teviet - - - - - ,

Cfutha ====J-_-,II-----,

Tuapeka Silverpeak - - - - ' Evansdale - - - - '

WoOdhaugh North-East

C

::y

_

Musselburg 51 Kilda W -----'1---1 MOmingTon Sawyers Ba - - - - ,

I~

en :E

~I----'

AbbotsfordKakanui - - - - ' Aviemore - - - , Dunsran - - - - '

0

}:>

Weston - - - -....

Waldronvil _ h

Kenmure ---'1---1

I:

«

I:

I;

I:

11\

I:

I I I I 'I

,I

'I

\,

I "­ I

I

I

--I

0

4

2

6

8

10

12

Myross_Bus

Makarewa

Otalara

Rosedale-W

Kervin_Hei

en 0

Skippers

Dacre WailUna

C

.....-+-

Charlton

::::r

Chanon

--

Kaweku

OJ

Hokonui

I

.·1

::J

Waianiwa

0..

Toeloes

0

Fairfax

Kaiwera

):>

Mararoa_Ri

C

Wairio

en

Waikaia

.1

I

I

I

.1

I

.I

.,1

.1

._. 1

__I

Mill_Road·

~

Wallacelow

.....-+­

Waikiwi

:::r

Oreti_Beac Te_Waewae

3

'·.West_Gore

0

:North_GOre

-C

Grasmere Newfield-R

CD

Hawthomda

.....-+­

:::r

Edendale_C

OJ

Winton

::J

RiYel'sdale South_Gore .".

W 0 0

'Lumsden_Co Otautau

Wyndham_Co

""0 CD

Glengarry

EascGore Nightcaps

-C

en

Riverton

0

Tuatapere

::J

Mataura

en

Strathern Appleby-Ke

0 -C 0..

Georgetown TlWaLPoin

CD -C

CD

Heidelberg KingswellSunshine_B

0..

Frankton Earns law

0­

Gladstone­

'<

Arrowtown

Queenstown Windsor

.,OJ

Richmond

m

0

OJ

Central_Go StewarUs

.1

I

I

Te_Anau

Otakaro_Pa

Ohai

Bruff

.c. ..

•....

~/

IJ

~

::... ~

~-!

J

PC analysis of 1986 rural area units

Of the 939 area units with more than 300 persons, 572 are urban and the remaining 367 are rural. The following table gives a comparison of the first principal component All

Rural

PMAORI

0.247

0.354

PISL

0.211

0.114

PSEPDIV

0.33

0.347

PNOTERT

0.186

0'.181

PSEEKRS

0.35

0.396

PBENEFS

0.397

0.437

PNOCAR

0.374

0.37

P1WOCAR

-0.367

-0.379

POWNED

-0.319

-0.088

PONEP

0.197 ,- 0.185

INCOME

-0.237

-0.195

The greatest differences are in PISL, PMAORI and POWNED. The difference in PISL, PMAORI should be obvious. The difference in POWNED arises because in rural neighbourhoods, POWNED has only small correlations with the other variables (highest correlation is -0.35 with PMAORI). If PISL is combined with PMAORI and POWNED is omitted:

All

Rural

PMAOISL

0.306

0.342

PSEPDIV

0.348

0.354

PNOTERT

0.218

0.181

PSEEKRS

0.378

0.394

PBENEFS

0.436

0.445

PNOCAR

0.380

0.375

P1WOCAR

-0.385

-0.383

PONEP

0.201

0.205

INCOME

-0.268

-0.207

50

IJ I~

I~

it

I~ I~

I" I> I)',' t

I: I: I~

I I

I

I I I

I

I

I

I

I .1 I --I :-'1

The correlation between the 9 variable HEQ and 1 ~ variable HEQ is 0.987 (on 996 area units).

K

Standard error calculations

A SHN factor is given by

a+bHEQ a + bHEQo To the first order

8( 5 H N F)

= --,8(--,a):. . ;. (l_ _S_H_N_F....:....)_+_8-,,-(b:.. .;(_H_E-C.Q_-_S_H_N_F_x_H_E_Q..:,..o-:..)

.) a+bHEQo

Hence the standard error is no more than

se(a)ll- SHNFI

.1

+ se(b)IHEQ a+bHEQo

I

I

-/ . 1 I

I

.1

.-1

--I

-I

_.1 _I

51

SHNF x HEQol

L

Ranking ofCAUs based on HEQa

HEQ(unscaled) rankings for CAUs with more than 300 persons:

Lowest 10% of HEQ scores Endeavour Bleakhouse Westmorland Maungamaungaroa Peacocke Chelsea Kennedys_Bush Cascades Shelly_park Discovery Khandallah Park Aokautere Papakowhai Holmwood Botany_Downs Mt Pleasant Lucken Point Normandale Churton Park Cashmere East Te_Kainga Kohimarama East Waitaramoa Tawa South Castor_Bay Campbells_Bay Waiata East Tamaki Fernleigh Orakei South

'

HEQa -4.1 -4

POP 1158

1719

-3.99 -3.82 -3.76 -3.75 -3.7 -3.52 -3.5 -3.48 -3.45 -3.44 -3.43 -3.36 -3.34 -3.33 -3.31 -3.3 -3.29 -3.28 -3.28 -3.27 -3.25 -3.22

729

1164

324

3213

303

1365

1887

2664

2286

rr22

1917

2268

3561

3591

1875

2058

3249

2895

3258

2994

3648

3486

3.22 -3.22 -3.22 -3.2 -3.16 -3.16

2517

1944

52

3501

756

468

2865

f

I

"'~

I

':

I:

(,

I:

I;

I

Ii

I,

I

I

I

I

I

I

-I

-I

---I

-I

-~I

--I

--I

I

I

I

--:-1

I

_-I

_-I

_I

_I

_I

_I

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Turanga Awarua Heretaunga_Park Wadestown Clarkville West Melton Deans Bush Sunnyhills Cashmere West Pauatahanui Whangapouri_Creek Greenacres Dairy_FIat-Redvale Cockle_Bay Carrington Glendpwie Myross_Bush Paremata-Postgate Belmont Taitapu Hingaia Woburn North Bucklands Beach South Karori East -,

Wairere Karaka_Bay-Worser_Bay Johnston Hill St Heliers Hawthornden Poraiti Riverhead Kelson Bastia Hill Mangaroa Maungaraki Kelvin_Heights

-3.16 -3.15

1290

3042

-3.12 -3.12 -3.11

1284 3006 690

3447 1575

-3.1 -3.1 -3.07 -3.06 -3.06 -3.04 -3.03 -3.02 -3.01 -2.99 -2.97 -2.97 -2.97 -2.97 -2.96 -2.95 -2.95 -2.94 -2.92 -2.91 -2.91 -2.91 -2.9 -2.9 -2.9 -2.89 -2.88 -2.84 -2.83 -2.83 -2.82

53







2589

2907

669

387

1140

1071

4146

612

3426

423

,2391

2886 426

579

1218 2223 3393 1419 1107 2301 3981 2250 519

1512















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693

885

3414

516

(; Mairangi Bay Meadowbank South Bucklands & Eastern Beaches Mana-Camborne Otipua_Creek-Washdyke Flat Pencarrow Pakuranga North Otatara Eastbourne Mellons_Bay Barrett Halfmoon_Bay Karoro Greenhithe Pahurehure Pinehaven Highlands_Park Otimai Governors_Bay Epsom South Chartwell Ngahinapouri Burns Point Maori Hill Murrays_Bay Kohimarama West Otamatea Avonhead Stirling Matangi Tahekeroa Halswell South Whakarongo Fairton Makara-Ohariu Community Long_Bay

-2.82 -2.81 -2.79 -2.79 -2.78 -2.78 -2.77 -2.77 -2.75 -2.75 -2.75 -2.74 -2.74 -2.73 -2.73 -2.72 -2.69 -2.69 -2.68 -2.65 -2.64 -2.63 -2.62 -2.62 -2.61 -2.6 -2.59 -2.59 -2.58 -2.58 2.57 -2.56 -2.56 -2.55 -2.55 -2.55 54

4503 3726 4068 1971 342

501

4089 2196 4590 2658 1074 3402 873

2511 2694 3276 1995

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2883

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Westburn Merrin Redoubt South Elsmore Park Russley Kaipaki Clifton Waima Lynmore Hunua East Taieri Manuka Pukete Paremoremo West Waipareira_West He 1 en?burgh Yaldhurst Murvale Rangoon_Heights Bryndwr Te Mata Fairfield Oaktree Springfield T irangi - South Korokoro Hutt Central Dacre Maewa Rosedale-Waverley Macandrew Bay Egmont_Village Woodend Makarewa Remuera West Longlands South

-2.55 -2.55 -2.54 -2.54 -2.54 -2.53 -2.53 -2.53 -2.52 -2.5 -2.5 -2.48 -2.48 -2.45 -2.44 -2.44 -2.43 -2.43 -2.42 -2.42 -2.42 -2.42 -2.41 -2.41 -2.41 -2.41 -2.4 -2.4

2490 1446 3204 2505 2718 687 1089 2058 2757 2529 1098 1716 2265 378 693 1038 624 3'555 1887 2520 4710 2097 3738 4005 2940 1188 3498 1692 ,'"

-2.39 -2.39 -2.38 -2.37 -2.37 -2.36 -2.36 -2.34

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336 3981 1395 489 1233 1290 2379 795

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Loburn Eyre AIgies_Bay-Mahurangi Tamahere-Tauwhare Brookvale Roseneath Ardmore Wright_Hill

-2.33 -2.31 -2.3 -2.3 -2.3 -2.29 -2.28

3453

Taupaki Oaklands Twyford

-2.28 -2.28 -2.28

660

4425

1050

Glenleith Masham Eureka

-2.27 -2.27 -2.26

531

2817

1701

HighestlO% of HEQ scores Homai West

HEQa 2.44

POP

1896

Highbury Maketu_Community Flaxmere East

2.44 2.45

3465

852

4185

4407



690

2.45 2.46 2.47 2.51 2.51

360

4935

3216

2.51

1467

High St-Stuart_St Bluff

2.52

2424

2.53

Blackball

2.53

2397

372

Vinet own pukehangi_North

2.54 2.55 2.57 2.61

Naenae North Kuratau Sydenham Surrey_Crescent Kawakawa

Mt Cook-Wallace Street Wesley Papakura_East Ngapuhi-Kaikou Whakaki

2.63 2.67 2.7

Turangi

2.71

56

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2223 2739 1998 4302





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1023

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Nuhaka Rowandale Elsdon Takapuwahia Levin South Masterton East Greyrnouth_Central Ngapuna Stanley_Park Lochain Shannon Castlecliff South Hamilton Central Grafton Rawene .Wembley_Park Avondale West . Awanui Waimana Cooks Gardens Ngaruawahia Koutu Opotik;i. Palmerston North Central Mahia Aranui Stuart St-Frederick St Mangere_Central Onehunga_South_East Masterton Central Tamarau Clendon Randwick Park Kaeo Arch Hill Moera Eden Terrace ,~;

2.76 2.78 2.78 2.79 2.79 2.8 2.82 2.83 2.84 2.85 2.87 2.9 2.9 2.93 2.93 2.95 2.99 3.01 3.01 3.02 3.03 3.03 3.03 3.03 3.04 3.06 3.07 3.07 3.07 3.09 3.1 3.1 3.11 3.12 3.13 3.13 57

336 2712 2397 2115 3639 690 900 2505 2967 1551 1581 2109 1206 447

1953

2736

345 597 444 5061 1977 4092 2871 825 4869 1881 2814 2388 666 2370 4197 2367 492 1032 1626 732

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I~ Fenton Grange Harania West Insoll Orini Te_Papapa wanganui_Central Raumanga_East Newtown East Riccarton South Mosston Kaikohe Glen Innes West Addington Laird Park Waltham Willis_Street-Cambridge_Terrace Gisborne_Airport South Richmond Matapihi Porirua East Kuirau Aro Street-Nairn Street Kaiti South Oranga Patea Favona Cathedral_Square Mascot South Dunedin Walmsley papakura_South Clover Park Otahuhu East Linwood Tokoroa Central

3.14 3.16 3.17 3.17 3.19 3.19 3.2 3.21 3.23 3.24 3.24 3.28 3.28 3.32 3.33 3.34 3.37 3.38 3.38 3.38 3.39 3.4 3.4 3.46 3.47 3.5 3.51 3.51 3.52 3.53 3.55 3.59 3.64 3.65 3.66 3.68

58

1314

1683

3843

2535

510

2430

1434

1740

4101

405

1308

4086

3630

2487

2478

903

420

2808

2325

504

2052

1314

2928

3063

2982

1482

4353

525

3600

2478

2841

1521

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6339

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3.69

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3.7 3.7 3.73 3.77 3.78

639 420 2268 372

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Tamaki Tuai Te Karaka Phillipstown High_St-The_Oval Otahuhu West Victoria Taita North Hokiariga_South Taneatua Community Flat Bush Harania East Camber ley Maraenui Mangakino Te Karia Ohura Botanic Gardens North_Cape Glen Innes East Harania North Murupara Cape_Runaway Moerewa Kingsley-Chatham Otago University East Cape Arahanga Tolaga_Bay

3.79 3.81 3.81 3.81 3.86 3.87 3.91 3.91 3.96 3.96 4.01 4.1 4.11 4.12 4.19 4.2 4.24

609

1470 3801 327 576

3204

1605

3618

1701

2805

2586

873

4008 3993

1950

3513 1578 315 333

4.25

2151

4.35 4.37

606

2652

3678

4.39 4.42 4.44 4.44

2376 1122

4.48 4.59

3138

3720

4.6 4.62 4.63

2973

1749

765

59

1884

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Porirua Central Gonville West Cannons Creek South Avon- Loop Oponae Otara North Otara East . Huntly_West Viscount Otara South Tokomaru_Bay Cannons Creek East Ratana_Community Crinan Otara West Ruatoria Ferguson Wiri Waitangirua Point_England Otangarei Kaingaroa_Forest Cannons- Creek North Balgownie Fordlands

4.63 4.65 4.68 4.75 4.77 4.82 4.84 4.86 4.88 4.93 5.05 5.09 5.1 5.22 5.24 5.37 5.41 5.5 5.63 5.7 5.93 5.96 6.04 6.69 6.76

60

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1719

3744

387

1539

4260

I:

3063 3507

3156

519

4164

426

2013

2859

849

4032

3162 4293

3594

2211

585

3627 435

2070

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Graphs

1. Admission rate vs domicile population 2. Comparison of HEQa and HEQ over 996 domiciles 3. Admission rate vs HEQa for domiciles with more than 300 persons 4. Admission rate vs HEQ for domiciles with more than 300 persons 5. DRG cost weighted admission rate vs HEQa for domiciles with more than 300 persons 6. DRG cost weighted admission rate vs HEQ for domiciles with more than 300 persons 7. st-census checks, and finds at least 1 percent of the '

population is missed. See C. Y. Choi, Population Estimates in Australia - A

Discussion Paper. Demography Research Papers~:Australian Bureau of Statistics, Canberra, July 1979. This reIX>rted, from a IX>st-enumeration survey, under­ enumeration of around 1.35 percent in the 1971 Census.)

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The Department adjusts the estimates forward by adding births and deducting deaths, for the region, and then further adjusting for the overall effects of internal and external migration. This last adjustment is an ad hoc process, using data on

dwelling completions, and school rolls, and also writing to local authorities for

information on developments in their area which will affect IX>pulation numbers. For external migration, information is extracted from the arrival and departure. cards on past or intended place of residence for "permanent or longterm" migrants (moving for twelve months or more), and used as input data at regional level.

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Department of Statistics defmitions and population estimates

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As mentioned the estimates are of "usually resident" IX>pulation. The Census population on this basis is obtained by allocating those away from home on Census night, back to the address where they usually live. (Those temporarily overseas at the time of the Census are missed from the Census count. However it is reasonable to assume that those overseas are a reasonably constant proIX>rtion of the population, and that it is people actually in New Zealand who determine demand on health services.) , The key Census question is "Where do you usually live?", accompanied by the following instructions: ". Indicate the address you have lived at (or intend to live at ) for at least three months . . If you have more than one New Zealand address, print the one where you spend the most time. Primary and secondary school students who board away from home and usually return home at the end of each term, should .... print their home address. University, other tertiary students, trainees or other persons living away from home, should print their present address if they have been (or will be) living there for at least three months. If you usually live overseas, print the name of the country lived in. "

7

There is some ambiguity in the first instruction for those just about to move. It is given in this form, however, to cover those who have just moved, and those who are about to move to a "permanent" residence and have not been in such in recent months. The ambiguity is for those who have had a "permanent" (3 months or longer) residence and are about to relocate. They could answer, eitht":r way. It seems impossible to avoid some ambiguity in this instruction, simply because for

some people (only a small minority of the population), "usual residence" is not a precisely definable concept.

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The Department of Statistics comments that their experience is that the question is not always correctly answered. The average person, where their situation is ambiguous, will tend to classify themselves accordi,ng to past residence, rather than future intentions. The Department has no quantitati,ve figures for respondent error rate on this question, but informally estimates the number of such people to be "in the thousands" (students being one category specifically mentioned). It should be added, however, that a considerable proportion of these would still be in the same Regional Health Authority area, for both "previous" and "future" residence.

III.

Who is entitled to access to subsidised health care?

Appendix I spells out in general terms who is eligible to receive the various health benefits. In summary, those entitled are ­ · New Zealand citizens (provided the service or good is received in New

Zealand). Cook Islanders, Niueans, and Tokelauans have New Zealand

citizenship.

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· Non-citizens "ordinarily resident" in New Zealand (usually for two years

or more).

· Visitors from Australia and the United Kingdom, under "reciprocal

agreements" .

· Classes of visitors approved by ministerial authority. In particular, students under MERT sponsorship. · All persons suffering injury by accident within New Zealand's tenitorial limits are entitled to treatment under Accident Compensation legislation on

the same terms as New Zealanders.

(Under ACC arrangements up till now, costs of treating accident

victims are taken into account in bulk funding of AHBs by government. The allOcation of funds between AHBs, however, might not fully allow for differences in numbers of accidents to overseas tourists. A possible arrangement in future would be for health service providers to bill ACC directly for treatment of accident victims, which would diminish the problem of some regions having more overseas visitors than others.

However, this has yet to be decided.)

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