Comparison of private for-profit with private community-governed not-for-profit primary care services in New Zealand Peter Crampton, Peter Davis 1 , Roy Lay-Yee 2 , Antony Raymont 3 , Christopher Forrest 4 , Barbara Starfield 4 Department of Public Health, Wellington School of Medicine and Health Sciences, Wellington, New Zealand; 1 Department of Public Health, Christchurch School of Medicine, Christchurch, New Zealand; 2 Centre for Health Services Research and Policy, School of Population Health, University of Auckland, Auckland; 3 Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand; 4 Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA Objective: To compare the characteristics of patients, their disease patterns, and the investigation and referral patterns in private community-governed not-for-profit and private for-profit primary care practices in New Zealand. Methods: Observational study using a representative survey of visits to general practitioners in New Zealand. Practices were categorised according to their ownership: private for-profit or private community-governed not-for- profit. Patient socio-demographic characteristics, treated prevalence and other characteristics of presenting problems, morbidity burden, numbers of investigations and referral patterns were compared. Results: Compared with for-profit practices, community-governed not-for-profit practices served a younger, largely non-European population, nearly three-quarters of whom had a means-tested benefit card (community services card), 10.5% of whom were not fluent in English, and the majority of whom lived in the 20% of areas ranked as the most deprived (by the NZDep2001 index of socio-economic deprivation). Patients visiting not-for-profit practices were diagnosed with more problems, including higher rates of asthma, diabetes and skin infections, but lower rates of chest infections. The duration of visits was also significantly longer. No differences were observed in the average number of laboratory tests ordered. The odds of specialist referral were higher in for-profit patients when confounding variables were controlled for. Conclusions: Community-governed not-for-profit practices in New Zealand serve a poor, largely non-European population who present with somewhat different rates of various problems compared with patients at for-profit practices. The study highlights for communities, policy-makers and purchasers the importance of community- governed not-for-profit practices in meeting the needs of low-income and minority population groups. Journal of Health Services Research & Policy Vol 9 Suppl 2, 2004: S2: 17–22 # The Royal Society of Medicine Press Ltd 2004 Introduction Ownership confers governance responsibility (ultimate control) for an organisation, and accountability for its actions. Primary care organisations can be classed as government owned and operated or privately owned and operated, with the latter being divided into those responsible to a community-governance board versus those not responsible to such a board. Community- governance seeks to ensure that an organisation is in the control of the users, constituents or clients of the organisation. 1 While there has been considerable research comparing for-profit and not-for-profit hospi- tals, 2,3 there is comparatively little research comparing for-profit and not-for-profit primary care practices. Ownership is important not only in New Zealand but also in the USA, where not-for-profit community health centres have been important sources of care for low- income and uninsured people since the late 1960s, 4 as well as in the UK, where there is growing diversity of ownership arrangements 5–8 and increasing emphasis on community involvement in governance in the newly formed primary care trusts. 9 Not-for-profit bodies are now involved in National Health Service (NHS) J Health Serv Res Policy Vol 9 Suppl 2 October 2004 S2:17 Original research Peter Crampton PhD, Senior Lecturer, Department of Public Health, Wellington School of Medicine and Health Sciences, Wellington. Peter Davis PhD, Professor, Department of Public Health, Christchurch School of Medicine, Christchurch. Roy Lay-Yee MA, Assistant Research Fellow, Centre for Health Services Research and Policy, School of Population Health, University of Auckland, Auckland. Antony Raymont PhD, Senior Research Fellow, Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand. Christo- pher Forrest PhD, Associate Professor, Barbara Starfield MD, University Distinguished Professor, Department of Health Policy and Manage- ment, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. Correspondence to: PC.