What you need to know about Entitlements

Why do some GPs charge so much more than others? It's all to do with a faulty funding formula which both major parties have promised to fix. Looks as if they still don't get it. We asked one of our members, Dr Andrew Miller, to comment. 

How you ever wondered why some general practices charge adults $18 and others charge anywhere from $35-65?. Well it's because the general practices are given different levels of government subsidy based on a historic and grossly inequitable funding formula which our current government has refused to review for the last nine years. Surprise, surprise but the election circus has seen Labour promise to review the general practice funding fiasco and National has followed suit.

However, neither major party seems to have any understanding about how funding is actually allocated so are both still way off the mark. It may be hard to believe but funding isn't based on the need of the patient. Funding is given to general practices for everyone enrolled in that practice not whether they can afford to pay for access or not. This system has 700,000 high needs patients paying high fees and 700,000 wage and salary earners paying low fees - nothing to do with the actual need or income of the patient. The better funded practices offering cheaper visits are called Very Low Cost Access. The lower funded practices charging the higher fees are called Access Practices.

Some practices have as low as 8% of their population deemed high needs/low income but can give the other 92% of their patients cheap visits. On the other hand some practices have close to 50% of their patients high needs/low income but don't get extra funding for these patients and have to charge them higher fees. This is clearly ludicrous and unjustifiable.

So what are the major parties promising? Both have said they'll give extra funding to all practices to give all high-needs/low income patients additional funding to allow cheaper visits. National would set the cheaper visit at $18 and Labour at $8. This is a really good idea but then both parties' policy promises unravel because they're going to leave the 700,000 wage and salary earners in the historically better funded practices still getting cheaper visits. So if Labour get in they've said some practices can offer $8 visits for all patients (regardless of need or income) and some practices can offer $8 visits for their higher needs patients and $32 for everyone else. National is $18 for all high needs patients and $35-65 for the rest. This remains grossly inequitable, illogical and may see the bankruptcy of about half of all general practices in NZ. If you fill your car up in one place for $1 but it cost $4 down the road I wonder where you'd decide to fill the tank? Don't you just love politicians!

Dr Andrew Miller