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Data relating to GMS claims for 1977/78 and 1978/79 were analysed from all health districts. Calculations from these and other sources showed a figure for 1978/79 of 2120 population per full time equivalent general practitioner ranging from 1685 in Whangarei to 2691 in Invercargill. A mean GMS claim of $2.87 was used to calculate utilisation rates. These similarly varied from 4.8 services per person per year in Whangarei to 2.8 in Invercargill and were highly correlated with availability. This and other evidence suggests that supply is determining demand. Mean utilisation rates increased over the above period from 3.7 to 3.8 pointing to the cost consequences of an increasing number of general practitioners.

Pooled data from clinical trials show that the incidence of fatal and nonfatal strokes combined is reduced by approximately 39% (95% CI: -48% to -28%) with antihypertensive treatment. However, given the relatively low incidence of stroke, it can be calculated that about 530 to 1375 mild to moderate hypertensive patients would need to be treated per year to prevent one stroke. Applying these results to the health service costs, both public and private, of treating mild to moderate hypertension in New Zealand we have estimated that the cost of preventing one stroke in those aged 35-64 years at between $110,900 and $285,400 in 1982 dollars. The offsetting hospital and community care costs to the health services of treating a stroke, was approximately $6500 giving a net cost of between $104,000 and $279,000 per stroke prevented. The cost of preventing a death from stroke was estimated to be between $356,000 and $1,822,000. Per year of life saved, this appears to be well in excess of such costly interventions as coronary artery bypass, heart transplantation and renal dialysis. Greater use should be made of inexpensive diuretics and nonpharmacological methods for the management of hypertension. A population strategy, rather than the present expensive high risk approach, could be far more cost effective in stroke prevention.

This study was undertaken to determine whether the relationship between availability (population/GP) and utilisation (services/person) shown in previous work also applied to general practitioner prescribing rates and costs. Pharmaceutical pricing office records of payments to pharmacists were used as a data base. Calculated rates of prescribing and costs for 1978/79 showed a wide variation between health districts ranging from 9.0 prescription items and $40.18 per capita in Whangarei, to 5.8 items and $26.83 in Invercargill. These rates were highly correlated with both availability and utilisation, thus indicating that the wide inequality in distribution of general practitioners is associated with an equivalent maldistribution of pharmaceutical expenditure. In 1978/79 each general practitioner on average issued 16315 prescriptions at a cost of $72 934. These findings have important cost and policy implications with the projected surplus of medical manpower seeking entry to general practice.

Using data from a variety of sources the availability and utilisation of beds for the treatment of the mental illness and mental handicap for hospital board populations have been determined. There is a wide variation in bed availability between such populations and this is significantly correlated with utilisation variables such as rates of first and total admissions, bed days and length of stay. There is little evidence of underprovision in low availability areas. On the other hand provision above the average is associated with both population-based overfunding and the possibility of serious detrimental effects due to institutionalisation. Excess beds may therefore lead to both expensive and poorer quality care. Guideline figures for New Zealand are suggested which are well below current provision.