Your Choices...Your Health What You'll Pay Information on what you’ll pay to see a doctor and for prescriptions is provided below. If you have further questions contact your Primary Health Organisation. You can also call the Ministry of Health’s helpline: 0800 020 007. How do I qualify to receive cheaper fees and cheaper prescriptions? Do refugees qualify? Are there limits placed on what GPs can charge the public? Why do I have to pay more than $25 to visit the doctor? What happens if I haven’t been to the doctor for three years? Why is there a three-month 'stand down' period when I have to pay higher fees? How much government funding do general practices receive? How do I qualify to receive cheaper fees and cheaper prescriptions? Everyone who is a New Zealand resident and is enrolled in a Primary Health Organisation now qualifies for cheaper fees and prescriptions. For prescriptions: there is no charge for most medicines for enrolled children under six enrolled people only pay a $3 charge for most medicines, if they get their prescription from the general practice where they are enrolled if you go to a hospital doctor, you may have to pay the $15 prescription charge for each medicine because hospital prescriptions are not covered by funding that goes to primary health organisations if you go to a practice where you are not enrolled, you may also have to pay the $15 prescription charge for each medicine if you have a Community Services Card or High Use Health Card, you will only pay $3 for each medicine. Back to top The following diagram illustrates what you’ll pay for prescriptions: Text description: If you are enrolled with a PHO, the prescription is written by your usual practice and you have a Prescription Subsidy Card then you'll pay $0. If you are enrolled with a PHO and the prescription is written by your usual practice then you'll pay $3. If you are under 6 then you'll pay $0. If you are not enrolled with a PHO but do have a Community Services Card or High Use Health Card and a Prescription Subsidy Card then you'll pay $0. If you are not enrolled with a PHO and do not have a Community Services Card or High Use Health Card but do have a Prescription Subsidy Card then you'll pay $2 . If you are not enrolled with a PHO, do not have a Community Services Card, High Use Health Card or Prescription Subsidy Card and are between 6 and 18 then you'll pay $10. If you are older then 18 then you'll pay $15. Do refugees qualify? People with refugee status in New Zealand are eligible for publicly funded health and disability services. They need to show proof of refugee status, for example, an approval letter from the New Zealand Immigration Service, a residence permit or a work permit for two or more years. People who are in the process of having an application for refugee status determined by the New Zealand Immigration Service or are in the process of having an appeal heard by the Refugee Status Appeal Authority are also eligible, but will need to show proof of an application, e.g. an acknowledgement letter from the Auckland Refugee Status Branch of the New Zealand Immigration Service. Back to top Are there limits placed on what GPs can charge the public? General practice fees are monitored by District Health Boards and general practice must comply with the process District Health Boards have negotiated for managing general practice fees. This is how it works: If the increase is above a nationally determined reasonable amount, then the District Health Board can refer it to an independent Fee Review Committee. The committee will look at the particular circumstances of the general practice and decide whether the increase is fair and reasonable given the circumstances. Primary Health Organisations are required to make information about the fees being charged available to the public. The Primary Health Organisation and District Health Board have to agree how fees information will be made public, but in most cases this information will be on the District Health Board’s and Primary Health Organisation's websites. Back to top Why do I have to pay more than $25 to visit the doctor? $25 is the national average. Fees vary. It’s worth remembering that most general practices operate as privately owned businesses and District Health Boards cannot cap doctors’ fees unless the practice agrees. What happens if I haven’t been to the doctor for three years? Your enrolment expires after three years. This means if you haven’t signed a re-enrolment form before the expiry date the fees you'll be charged will not be subsidised. You don’t have to visit the doctor to be re-enrolled. You can ring and ask your general practice to send you an enrolment form, sign it and send it back to them. Back to top Why is there a three-month 'stand down' period when I have to pay higher fees? 25% of practices charge low fees which are capped. These practices are called Very Low Cost Access Practices and they provide free consultations for under 6s and charge a maximum of $10-50 for 6 to 17 year olds, and $15-50 for people 18 years and over. Any practice can sign up as a Very Low Cost Access practice, as long as they agree to charge these low fees. Some general practices say they have to charge until they get your funding. These general practices say that until the funding is confirmed, charging the low fee is risky. The Ministry of Health agrees with those practices that charge low fees from the start. It believes that people should be charged the lower fee as soon as they enroll, and that the funding arrangements provide for this. The Ministry has asked District Health Boards who hold the contracts with Primary Health Organisations to follow up on instances where new enrollees face a ‘stand down’ period. If your new general practice tells you you’ll face a ‘stand down’ period, you can let your District Health Board know about it. The District Health Board will contact the Primary Health Organisation and ask them to follow up with the practice. You can ask the District Health Board to keep your name confidential if you're worried it might affect your relationship with your new doctor. Back to top How much government funding do general practices receive? The figure is between $500 and $600million. The amount of funding a general practice receives is determined by the number, age and gender of their enrolled population. This funding is not tied to how many times you visit your general practice. Every quarter the Primary Health Organisations send their enrolment register to the Ministry of Health and the Ministry calculates how much funding the Primary Health Organisation should receive. The funding rates are provided below: Ministry of Health's Annual Funding Rates for Primary Health Organisations 1 July 2007 – 30 June 2008 Note: Figures are GST exclusive and rounded For girls aged 0 – 4 $344.04 For boys aged 0 – 4 $362.23 For girls aged 5 – 14 $108.90 For boys aged 5 – 14 $101.93 For females 15 – 24 $100.49 For males 15 – 24 $55.31 For women aged 25 – 44 $88.30 For men aged 25 – 44 $57.08 For women aged 45 – 64 $120.95 For men aged 45 – 64 $90.33 For women over 65 $208.43 For men over 65 $179.74 If the person has a High Use Health Card, they are classed as a high need person so the funding rate the general practice receives is higher, but there may be no difference in what the general practice charges these patients. The annual funding rate to the primary health organisation for high need people is: For children aged 0 – 4 $514.28 For children aged 5 – 14 $329.75 For patients aged 15 – 44 $317.64 For patients aged 45 – 64 $347.90 For patients over 65 $373.11 More information on Funding can be found in the Primary Health Care section: Primary Health Care Funding Back to top Website feedback We welcome your feedback on this page. Page last updated: 5 October 2007

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