Doctors’ fair funding call
GP consultation fees vary unfairly around the country say medics. Susan Edmunds reports.
Doctors say a fairer system is needed to determine how much a basic visit to the GP will cost. A survey this week of the cost of a GP appointment, shows big differences around the country.
Some doctors charge more than $60 for their 15-minute consultations for an adult, while others - even within the same city - only ask $10.
In some parts of the country, such as Rotorua, there are free doctors’ visits for young adults.
Royal New Zealand College of General Practitioners president Tim Malloy, said the cost of a basic consultation for an adult patient would generally be somewhere between $50 and $75.
But how much of that the patient would pick up would depend on the level of state subsidy the doctor received.
When you enrol as a patient with a doctor who is part of one of the country’s 32 primary health organisations (PHOs), the GP is able to access subsidies for your care. About 300 GP practices operate under the ’’very low cost access’’ scheme.
The Government provides more funding to these doctors, operating in areas where the local population is made up of 50 per cent or more patients classified as ‘‘high needs’’. They must also agree to keep fees to a maximum $12 for teenagers and $18 for adults.
About 30 per cent of the population is enrolled with these practices.
Malloy said the system was problematic because people could be wealthy but living in a more deprived area, and receive very cheap health care because of it. ‘‘And a major disadvantage is that lots of people who are ‘deprived’ do not live in a ‘deprived’ area,’’ he said.
About 44 per cent of all ‘‘high needs’’ patients are enrolled with a GP practice that is not part of the VLCA scheme.
Malloy pointed to a recent Ministry of Health survey, which found one in nine New Zealanders are not getting GP care that they need because they cannot afford it.
He said the cost of a doctor’s visit was a big factor for many people deciding where to go.
‘‘For the most part the cost is the single most important variable for people who are deprived – beggars cannot be choosers.’’
Auckland woman Amy Duncan said she tried to limit her visits to keep the cost down.
‘‘I won’t go to the doctor unless absolutely necessary. I usually take a list of things I need to discuss with the doctor just so I feel like I’m getting my $56 worth of a 15-minute appointment. My doctors are very strict on being 15 minutes only, they will even book you in again if you need to go over that 15 minutes and charge you another $56.’’
She said she was considering moving to a cheaper practice because $56 was about half what she earned in a day.
‘‘The only reason I haven’t yet is because I’ve gone to the same GP since I was four and I feel comfortable there. I have found another GP not too much further that is $41 an adult visit and they’re also open seven days a week, only closed on Christmas. I went there once and they were great so I will be having my records transferred when I next need to see a doctor.’’
A solution would be to target funding to the patient as opposed to the practice, Malloy said.
But he said that was not straightforward either because it would be hard to keep the system updated as people’s circumstances changed.
‘‘Our argument is it’s got a lot to do with the fact that the value of the subsidy investment the state has made in primary care has eroded over time, it hasn’t kept up with that initial investment so gradually, but surely prices are getting higher and higher for the patient.
‘‘Unless there is greater investment in primary care subsidies by the state or the model is directed to those who need it, that will probably continue for some time.’’
Other factors also played a smaller part in what patients were changed, he said.
‘‘There are other overheads they may have to cover, rent in some places is much higher, in some places they might have to pay for parking whereas in the middle of nowhere it might be free… there is a multiplicity of variables but in the most part the labour costs are the same and they make up the majority of the expenses of a practice.’’
Health Minister Jonathan Coleman said he was working on ways to better target funding to high-needs populations, without making others pay more.
He had received advice that showed more than two million patients would have to pay higher fees to support lower-cost access for the 700,000 low-income patients who currently do not qualify for the cheapest access. ‘‘I will not be making any changes that result in some patients paying more than they currently do.’’