Protecting primary healthcare funding in Aotearoa New Zealand: a cross-sectional analysis of funding data 2009-2023.

Introduction In 2001, Aotearoa New Zealand (NZ) launched a Primary Health Care (PHC) Strategy to improve access, reduce inequities, and shift care toward the community level. Those goals have remained in place since. Despite initial successes, multiple challenges indicate PHC remains underfunded. Aim This study aims to assess the extent to which PHC has been financially prioritised within public spending between 2009 and 2023. Methods We use Ministry of Health transfers to Primary Health Organisations (PHOs) as a proxy for PHC funding, including general practice capitation and PHC capacity investments. We analyse PHC funding trends relative to total government health funding, adjusted for inflation, in total and per capita terms, and examine changes in key funding streams. Results On average, NZ spent NZ$238 per person per year on PHC in 2023 prices, reflecting a slight 7% increase since 2009. Although PHO funding has diversified over time, it remains dominated by First Contact Funding, which accounted for 70% of total PHC funding. On average, NZ allocated 5.4% of its national health budget to PHC, a share that did not change throughout the study period. Discussion The findings highlight the need for greater financial prioritisation of PHC in NZ to fulfil the PHC Strategy. Despite nominal increases, the static share of PHC funding suggests that successive governments have not sufficiently prioritised PHC funding to align with their strategic PHC goals. We recommend routine monitoring of PHC funding relative to the total government health budget and setting a minimum allocation to help protect spending on PHC.