Fee anomaly to access healthcare

BY DENISE PIPER

Low income patients may have to switch doctors to afford healthcare under Whangarei's fees scheme.

A third of Whangarei patients pay up to twice as much as others because of the doctor they go to.

Fifteen out of 22 general practices in Whangarei belong to the low-cost access scheme, where they get an extra subsidy from the Health Ministry in return for keeping fees low.

Patients belonging to these practices, regardless of income or need, pay the low fees – about $16 for an adult.

But the remaining seven practices are now effectively locked out of the scheme after strict entry criteria was introduced in October 2009.

Four practices were about to enter the scheme when the rules were changed and now do not meet the criteria of at least 50 percent high-needs patients – classed around ethnicity and socio-economic factors.

Practices within walking distance in central Whangarei have charges ranging from $15 to $34 because two belong to the scheme and two do not.

Manaia Primary Health Organisation chief executive Chris Farrelly says his concern is for high-needs patients who are not getting the low fees.

Evidence shows if people can not afford to go to the doctor they will put off a visit, sometimes until they need to be hospitalised, he says.

"We agree high-need people have to have access to cheaper fees. We have evidence, categorically, that price impacts access."

Mr Farrelly says some patients now literally can not afford to go to the doctor and are visi-ting less regularly than they should, missing regular tests.

Other patients are voting with their feet.

Last year Whangarei practices on the scheme gained 997 patients, while those that weren’t lost 117.

Given the limited health budget, Mr Farrelly says one solution could be only high-needs patients get the lower fees, like the former
community services card scheme.

That would mean patients who are not high-needs enrolled with low-cost access providers would have to pay more.

Mr Farrelly says he would like feedback on that.

Health Minister Tony Ryall says the low-cost access scheme was introduced by the previous government in October 2006.

General practices have had three years to join before changes to the entry criteria took effect, he says.

Mr Ryall would not say why the changes were made or what he thought of the low fees being offered to just high-needs patients.

He says he is advised general movement between low-cost access providers and practices not on the scheme in Whangarei appear to have been reasonably stable over the past year.

The government’s pre-election policy is clear that it will continue universal subsidies for GP visits, he says.

All Whangarei practices offer free healthcare to under six-year-olds.

- © Fairfax NZ News