Rural doctors are concerned a potential wave of COVID-19 infections will overwhelm isolated health clinics, who don't have the resourcing, staff or support from district health boards (DHBs) required to handle it effectively.
Experts at the University of Otago interviewed 17 senior rural doctors on how they've handled COVID-19 to date, and problems that might arise should the virus arrive in their communities.
While there was relief there hadn't been a widespread outbreak to stress the system, as there have been in other countries where rural death rates are higher than in the cities, they fear what's to come.
"It was common to feel both forgotten by the DHB and at the same time overwhelmed by masses of often contradictory information that was not always relevant to their situation," the New Zealand Medical Journal, which published the research on Friday, said in a statement.
"The rural doctors were concerned about the ability of their local facilities to handle large numbers of seriously unwell and highly infectious patients, but were even more concerned about the ability of the system to transport those needing advanced care to the base hospital."
Study author Kati Blattner - a rural doctor and senior lecturer at the University of Otago - told The AM Show on Friday rural Kiwis trust their local health providers, but much of the COVID-19 response - such as the vaccine rollout - has been hampered by a reliance on DHBs, which cover wide-ranging areas.
"Rural health services who are well-known to communities and know the back roads and valleys, all the people that live there and who's related to, they were given control over the vaccination programmes in their areas too slowly. They now do have them, but it happened too slowly."
Rural parts of New Zealand are generally poorer, older and have large Māori populations, her paper noted, all risk factors for COVID-19. About 10 percent of the population are served by rural hospitals.
The surveyed doctors also highlighted likely problems in getting potential COVID-19 patients the required hospital care quickly enough.
"From home, which might be on a remote beach in Northland or down on the West Coast, when a person gets sick in a rural area they will travel often to a clinic and be seen by a GP or a nurse practitioner. From there, if care needs to be escalated, they will often go to the local rural hospital...
"But rural hospitals don't have specialists or a lot of diagnostics. The medical workforce in rural hospitals is rural GPs and rural hospital medicine specialists, and certainly no ICUs or anaesthetics or surgical services."
There's also third parties in the mix, such as St John and retrieval services, complicating the transfer of patients between rural hospitals and those in the cities with better facilities and specialist staff. Ambulances sometimes take a few hours to arrive in remote parts of the country.
"A lot of it is around the misunderstanding or not understanding the rural context by those centrally," said Dr Blattner. "In those places where the rural hospital and the DHB before the pandmeic was strong… then things worked a lot better."
Dr Blattner's paper concludes rural health services need to be considered at a national level, rather than being left to DHBs, which are being scrapped soon anyway.
"Rural hospitals appear to be uniquely positioned to improve health equity for rural communities, particularly for Māori and Pacific peoples," it reads. "Further research, strategy and policy at a national level is needed if they are to fully realise this potential."