Patients of some doctors in the Nelson region are paying $15 to $21.50 more a visit than the lowest fee.

A look at fees across the region shows a significant variance in price among the 25 centres.

It shows that while a patient in the 18 to 24 age bracket pays $22 at one medical centre, the same age group is charged $43.50 at another.

Motueka practice, Drs Parker and Quick, have some of the region's lowest fees and say providing affordable healthcare and a safe place to go is more of a concern than fee revenue.

More than half the practices in the region had a fee rise at the start of this month.

But, Drs Parker and Quick practice manager said their fees had not gone up since 2010, because of "ethics".

"We just like to make our patients feel they can come and afford to come in. We still want to make GP visits affordable."

They were a "very, very, very busy" practice, and price was only one factor why people continued to come, she said.

However, Nelson GPs' spokesman Graham Loveridge said the variance between practices was mostly a historical thing, based on what practices were charging years ago when the government funding scheme came in.

If the practices had low fees when they entered into the scheme they would continue to do so, because of the capitation the Government had on how much fees could be increased, he said.

"It's always a struggle, how to set fees. General practice is expensive to run, staffing, rent, bills.

"It's been a struggle to keep GP incomes in the same realm as hospital doctors as well."

If those fees were not kept similar, it would be hard to encourage younger doctors to move into general practice, which was important, Dr Loveridge said.

Nelson Marlborough District Health Board community based services director Peter Burton said the funding model, introduced under the last Labour government, saw doctors receive about half and half funding from fees and the Government.

Practices could apply to have their fees increase, the most common reason for which was to cover costs, he said.

"Essentially the basis [of approval] is a reasonable fee increase. The aim is to keep the government contributions in line with patients' contributions so that general practice remains accessible and not too expensive."

An independent review board also looked at the fees, he said.

"There are some for whom the costs of going to the GP is a barrier, therefore, the steps are to generally make it more accessible. You get a better health outcome with people going to see their GP, it's good for people's health."

Both Wakefield Health Centre and Tasman Medical Centre have some of the highest fees for enrolled patients in the region.

Wakefield's practice manager Jo Francois said its fees had gone up this year by about 3 per cent, but not in all age categories.

"It was the increase we were allowed from the [Health Ministry]. We haven't put them up for a wee while, at least a few years."

The decision to increase the fees was because of the extra costs, including medical supplies and higher power bills.

Ms Francois said she did not want to comment on the fact its fees were some of the most expensive in the region.

"But I think the service we offer our patients is great."

The two lowest priced practices in the Nelson Tasman region are St Luke's Health Centre and Central Medical Motueka.

Both are part of the governments Very Low Cost Access payment scheme, which means they receive extra funding to keep fees low, forgoing fee revenue.

To be eligible for the VLCA funding, practices must have zero fees for children under 5, an $11.50 maximum for children 6 to 17 years old and a $17 maximum for all adults 18 years and over.

The Health Ministry's website said practices that charge very low fees generally serve high-needs communities.

- © Fairfax NZ News

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