Media Release

19 August 2004

Research confirms doctor’s visits more affordable for two million New Zealanders

The Ministry of Health today released research that shows Primary Health Organisation (PHO) family doctor visits have become more affordable for half the country’s population.

A summary of key findings from five reports shows that before implementation of the Primary Health Care Strategy, there were clearly identified cost barriers to people getting general practitioner (GP) care.

Those most likely to be put off from visiting a GP because of cost were those living in areas of high deprivation, Māori and Pacific people.

Ministry spokesman Dr Jim Primrose said recent analysis of GP fees has confirmed that visits to Access-funded PHO practices – those with 50 percent or more low-income, Māori or Pacific peoples on their register – cost significantly less than fees charged by Interim-funded PHO practices.

"The overall key findings show that Access-funded practice fees are lower even for those age groups – school-age children and those aged 65 years and older – for whom Interim-funded PHO practices are receiving similar levels of captitation funding," he said.

"This supports the Government’s decision to start implementing the Primary Health Care Strategy by making sure extra funding goes first to those PHOs who serve populations of people facing the greatest financial barriers to care."

There are 73 PHOs covering about 3.57 million New Zealanders around the country. Of these, about 1.08 million can get primary health care from Access-funded practices. However, the total number of people who can get low or reduced-cost care through their PHO practice rises to 2.04 million when the children and older age groups visiting Interim-funded practices are taken into account.

Dr Primrose noted that the National GP Fees Survey carried out in February this year shows that 82 percent of the practices surveyed did not charge children aged under six for standard consultations. Overall, the average charge for these children was $1.59.

This survey also shows that Interim-funded practice fees for 6 to 17 year olds who didn’t have a Community Services Card (CSC) reduced on average by about $22 compared with unsubsidised adults in PHOs. For CSC holders aged 6 to 17, the reduction was $24.50.
Extra Government funding became available to Interim-funded practices from 1 October 2003, to help lower costs for children aged 6 to 17. There are now about 422,300 youngsters in this age group who are covered by Interim practices.

From 1 July this year, funding was increased by about $47 million to help reduce doctor’s fees in Interim practices for people aged 65 years and older.

Dr Primrose said analysis shows that on average, Interim PHOs reduced fees for their non-CSC holding senior citizens by $23.40. The average fee charged to those over 65 years was $24.65, although there were wide variations in different District Health Board (DHB) areas.

There are more than 339,000 older New Zealanders who can get low or reduced cost care through their Interim practices, and a further 102,000 people aged 65 and over are covered by Access-funded practices.

The February survey also revealed that fees charged in Interim PHOs were on average slightly higher across all age groups than those in non-PHO practices.

As well, the average unsubsidised fee for people aged 65 years and over appears to have increased by 11.7 percent between February and July this year.

One explanation for this is that when PHO general practices notify future fees, they tend to review their current fee, putting it up before committing to it.

PHOs have now agreed to notify any further increases in fees and DHBs are able to set up a fee review committee if they consider any rises are unreasonable.

Dr Primrose said the Ministry will continue to support DHBs as they work with PHOs on reducing GP fees.

"It’s important we know what is being charged out there in communities. This is the first time we have been able to analyse in such detail the financial impact PHOs and the Primary Health Care Strategy is having on the pockets of New Zealanders.

"Reduced fees is one measure of the success of the strategy and DHBs will report each quarter on any increased fees that have been notified by their PHOs."

Under the terms of agreement for getting public funding, all general practices have to display their charges where patients can easily see them.

Dr Primrose said that knowing what fees to expect was an important part of an individual’s decision to get care, and this information needed to be easily available.

View: General Practitioner Fees Information: A summary of key findings from five reports

ENDS

Background

Questions and Answers about General Practitioner Fees Findings

Where has this research about general practitioner (GP) fees information come from?
The Ministry of Health has analysed information from five reports dealing with aspects of GP fees information and summarised the key findings.

What are the five reports?

1. First Report and Recommendations of the Commonwealth Fund’s International Working Group on Quality Indicators – A Report to Health Ministers of Australia, Canada, New Zealand, the United Kingdom and the United States, June 2004;
2. Cost Barriers to Health Care: Analysis of the 2002/03 New Zealand Health Survey – Antony Raymont, Senior Research Fellow, Health Services Research Centre, Victoria University of Wellington, July 2004 (Provisional);
3. Primary Health/PHO Communications Campaign Research, June 2004, Alan Wylie (PhD), Phoenix Research;
4. National GP Fee Survey, CBG Health Research Limited, February 2004;
5. Information on fees notified by Interim PHO practices to be charged from 1 July 2004 to those aged 65 years and more.

(For links to the other four reports above visit: General Practitioner Fees in New Zealand: A summary of key findings from five reports)

Why is information on GP fees important?
There is clear evidence that for some groups of people, the cost of visiting a family doctor is a barrier to getting appropriate primary health care services.
The Government is making a significant investment in primary health care to reduce this financial barrier, improve all New Zealanders' health and address health disparities.
Improved access to general practice services through reduced PHO family doctor fees is one way to measure the success of the Primary Health Care Strategy.
In addition, everyone eligible for low or reduced cost care through their PHO family doctor also pays no more than $3 for most medicines, as long as they get a prescription from their regular PHO practice.

How significant is this analysis?
New Zealand GP fees information has never before been captured in the detail shown by these reports. To ensure better access to primary care services it's important that people know the fees they can expect to pay. This is information that plays a key part in an individual's decision-making process about whether to get care for themselves or their family. The Ministry of Health will work with DHBs and PHOs to make sure fees information is easily accessible by New Zealanders.

How are fees set, given that many of the GPs receiving Government funding through PHOs are in private practice?
GPs still retain the right to set their own fees but these must be low or reduced for those groups of people benefiting from extra Government funding. Practice fees are set after consultation between the PHO and the relevant district health board (DHB).

What should someone do if they're concerned about the fees they are being charged?
They should talk first to their practice. They can also raise their concerns with their PHO and DHB. All general practices getting Government funding are required to display their charges in a place where their patients can easily see them.

How many PHO practices are there?
There are a total of 1010 - 306 Access-funded practices and 704 Interim-funded practices.

How many people belong to the 73 PHOs?
About 3.57 million people are covered by the country's PHOs. Every DHB has at least one PHO in its region. Thirty-six PHOs are Access funded, 21 are Interim funded and 16 are mixed (Interim PHOs with some practices in the area that qualify for Access funding).

Why are there different funding formulae for PHOs?
PHOs have now been with us for two years.
To make the biggest difference for those who need it most, the Government started by targeting funding at high needs areas first through Access PHOs, to allow practices to reduce fees for all patients. There are now 36 Access PHOs around the country.
When the first two PHOs were set up in July 2002, about 30,000 people were eligible for Access-level funding. There are now about 1.08 million people receiving low or reduced costs through their Access PHOs.
But the Government is also making sure other groups can benefit through Interim-funded PHO practices as quickly as possible as well.
This has started with extra funding for children aged 6-17 years in October 2003, low-cost prescription fees for many medicines for high needs groups from 1 April 2004, as well as the extra funding for older people aged 65 years and over from 1 July 2004.

How much money is going into implementing the Primary Health Care Strategy?
In total, the Government will have committed $1.7 billion over six years from 2002/03 specifically for implementing the Strategy using the PHO model.
When will the rest of New Zealand be able to benefit from extra Government funding to reduce doctor's fees and prescription fees for most medicines?
All New Zealanders will be entitled to cheaper primary health care such as doctors’ visits and prescriptions by July 2007. The Government will roll out extra funding for 18 to 24 year-olds enrolled in Interim PHOs in July next year. People aged 45 to 64 will benefit in July 2006, and everyone else, 25 to 44-year-olds, will benefit from July 2007.