New Zealanders over 13 need to be dying to qualify for free visits to the GP. Only adults who have a terminal condition receive free or low cost care in many parts of the country.

Primary healthcare is unaffordable for a lot of people, even for elderly patients with ongoing cancer needs. Unless their local clinic qualifies for the Very Low Cost Access Scheme, they will pay through the nose to see a GP, anywhere between $42 to $60.

What is the Very Low Cost Access Scheme? It is a government policy where Primary Health Organisations provide generous funding to GPs who have over 50% of patients with “high needs”. This means that areas where there is deemed to be social deprivation will get the funding whereas no clinic on Auckland’s North Shore for example qualifies.

A quick scan of 2014 GP fees in the Waitemata DHB area shows almost universally high fees apart from in the West Auckland area. One clinic in Glenfield presently has lower fees ($37) but it is the exception on the North Shore. Parts of Auckland which once had a lower socioeconomic status are still heavily subsidised. A clinic in Onehunga, for example, charges $17 for an adult.

In effect, a millionaire in Whangarei (or Onehunga!) will pay about $17 to $20 to see a GP whereas a 70 year old cancer patient with a Community Services Card (meaning a very low income) will pay nearly $60 in Silverdale.

Clinics receive funding for terminal patients and for patients with two (not one) serious health issues. The latter will receive four well-subsidised appointments a year under the Care Plus scheme.

The Community Services Card is of very little use for primary care, providing a small discount for after hours care.

There is some “flexibility” in the system. The cancer patient with serious long term side-effects but who does not qualify for Care Plus because she has only one condition, can ask for the four subsidised visits but they won’t be offered. Patients have told me that they find out about this through hearsay.

GP clinics also have access to a small pool of money through an SIA scheme to help people who need special help but once again, it is not advertised and has to be asked for.

Elderly patients in the majority of clinics in the Waitemata District Health Board’s GP clinics pay as much or nearly as much as a younger working adult. I saw on the Ministry website that GP clinics get different capitation rates for different categories of patients. People of my age (70) are more highly funded than a 34 year old for example.

So why do I as a superannuitant with little other money, four cancers under my belt and a Community Services Card have to pay the same fee? The answer is that the capitation rate is per enrolled patient not per visit. On average, someone over 65 sees a GP many more times than a younger person, thereby using up the pool of money allocated for that age group. Ironically, those of us who avoid the GP suffer because others of our age visit him/her so often!

Two things spring to mind. GP clinics are private businesses. They are developing expensive looking medical centres with an impressive range of services. They have to pay for their buildings which are much more costly in cities than in rural areas. Many of their clients will have private medical insurance, some of which will pay for GP visits.

For a fair number of retired people or cancer patients whose household is down to one income, neither medical insurance nor GP visits are truly affordable any more.

This is based on research and phone calls. Please let me know if there are any inaccuracies or omissions. Maureen.

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Diana Ayling

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    • I am talking to David Seymore next week and will raise this along with a couple of other things. Great work, investigator. Maybe we should all tweet our Dr's fees. #FairtreatmentNZ
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