High-income countries like Aotearoa New Zealand are grappling with inequitable access to healthcare services. Out-of-pocket payments can lead to the reduced use of appropriate healthcare services, poorer health outcomes, and catastrophic health expenses. To advance our knowledge, this systematic review asks, “What interventions aim to reduce cost barriers for health users when accessing primary healthcare in high-income countries?” The search strategy comprised three bibliographic databases (Dimensions, Embase, and Medline Web of Science). Two authors selected studies for inclusion; discrepancies were resolved by a third reviewer. All articles published in English from 2000 to May 2022 and that reported on outcomes of interventions that aimed to reduce cost barriers for health users to access primary healthcare in high-income countries were eligible for inclusion. Two blinded authors independently assessed article quality using the Critical Appraisal Skills Program. Relevant data were extracted and analyzed in a narrative synthesis. Forty-three publications involving 18,861,890 participants and 6831 practices (or physicians) met the inclusion criteria. Interventions reported in the literature included removing out-of-pocket costs, implementing nonprofit organizations and community programs, additional workforce, and alternative payment methods. Interventions that involved eliminating or reducing out-of-pocket costs substantially increased healthcare utilization. Where reported, initiatives generally found financial savings at the system level. Health system initiatives generally, but not consistently, were associated with improved access to healthcare services.

Introduction: Long COVID is a multi‐system condition that affects an increasing number of individuals. Little is known about the support needs of people living with long COVID in Aotearoa New Zealand. This study aimed to explore the lived experiences and healthcare access challenges of people with long COVID to better inform service design. Methods: Co‐design methodology was used, informed by the Stanford Design Thinking process and knowledge mobilisation approaches. Participants were recruited via snowballing, through professional networks and support groups. People with lived experience of long COVID were invited to participate in a 2‐h workshop, facilitated by researchers, conducted between March and September 2024. Participants were asked to create a depiction of their experience of long COVID and describe their creation to the group; descriptions were audio‐recorded, transcribed and thematically analysed. The inclusion of people with lived experience of long COVID as co‐investigators ensured that the study was designed and conducted to forefront their knowledge and experience. Results: Eight workshops were conducted, including 30 participants, between March and August 2024. Of these, 25 (83%) were female; of the 25 who provided their age, most were aged 45 to 64 years ( n = 18, 72%), four (16%) were aged 25 to 44 years and three (12%) aged 65 years or older. Five key themes emerged: (i) lack of assistance; (ii) systemic barriers; (iii) absence of long COVID clinics; (iv) financial strain; and (v) low quality of care. A sixth theme identified personal coping strategies. Conclusions: Individuals with long COVID in Aotearoa New Zealand face major barriers to care, including inadequate services, financial hardship, and fragmented healthcare pathways. Findings support improved pathways and primary health care education in long COVID. A person‐centred, coordinated, and accessible model of care is needed. Lived Experience or Public Contribution: The study was designed with two people with lived experience of long COVID included as co‐investigators, and a further one on the Advisory Board. All participants had lived experience of long COVID.