Original Research

The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study


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Katharina Blattner1
MHealSc, Senior Lecturer *

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Lynne Clay2
PhD, Research Fellow

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Garry Nixon3
MD, Associate Professor

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Lauralie Richard4
PhD, Senior Research Fellow

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Rory Miller5
MBChB, Senior Lecturer

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Sue Crengle6
(Kāi Tahu, Kāti Māmoe, Waitaha) PhD, Professor

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Ray Anton7
MA(Management), CEO Clutha Community Health Company

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Tim Stokes8
PhD, Professor


1, 2, 3, 4, 5, 8 Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand

6 Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand

7 Clutha Health First, 9–11 Charlotte St, Balclutha, New Zealand

ACCEPTED: 24 November 2022

early abstract:

Introduction: In New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas and this is accentuated for Māori. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for healthcare. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system.
Methods: A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants’ views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework- guided rapid analysis method.
Results: Twenty-seven semi-structured interviews were conducted via videoconference. Two broad themes were identified: Theme 1. ‘Our place and our people’ reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital’s response. Local services were provided by small adaptable teams across broad scopes and blurred primary -secondary care boundaries, with acute and in-patient care a key component. Rural hospitals acted as a conduit between community-based care and city -based secondary or tertiary hospital care. Theme 2. ‘Our positioning in the wider health system’ related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being ‘at the end of the dripline’. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them.
Conclusions: This study furthers our understanding of the place of rural hospitals in the New Zealand healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Māori.