Government acts to end 'doctor-shopping'

By MARTIN JOHNSTON health reporter

The Government is tightening its flagship policy for improving frontline healthcare because more than 160,000 patients have flouted the rules.

It wants people to stick with one GP or clinic so the staff can manage their healthcare better, but an audit has revealed widespread "doctor-shopping", especially in Auckland.

Officials fear some people's health is being compromised by this, since doctors in some cases do not have access to vital patient records from other clinics.

Nationally, 8.6 per cent of enrolments in primary health organisations (PHOs) - umbrella groups for frontline healthcare - are of patients who have enrolled in two or more.

Worst is the Counties Manukau health district, where 13.6 per cent of enrolments are so-called duplicates, followed by central Auckland on 12 per cent.

To combat this, the Health Ministry is planning a public education campaign and has beefed up the enrolment criteria. These are among 33 recommendations, some related to improved computer software, now being implemented or discussed further after months of study.

To enrol patients, practices now have the formal, extra requirement of seeking their approval to obtain their medical records, if they are shifting from another PHO.

"It is about putting more onus on the practice and the patient to acknowledge that enrolment is happening," Chris Mules, a Counties Manukau District Health Board manager, said yesterday.

PHOs are the Government's vehicle for delivering lower-cost primary healthcare to millions of New Zealanders.

It wants them set up nationwide. So far there are 53, the first of which were created in July last year.

The Government is spending more than $400 million extra over three years on implementing its primary healthcare strategy.

It eventually wants lower-cost primary health care for all, and so far PHOs are delivering it to about half of those enrolled. The organisations in areas of greater poverty and with larger Maori or Pacific Island populations are given more funding per capita, although rich people in these PHOs are entitled to the cheaper care too, as are under-18-year-olds in any of the organisations.

The study also shows that many patients make casual visits to after-hours clinics or other doctors outside the PHO in which they are enrolled.

This and dual enrolments have caused financial difficulties for some PHOs, as the taxpayer funding follows patients.

About 8 per cent of the Government's bulk funding for primary healthcare is spent on patients' casual medical visits outside their "home" PHOs. The money is deducted from these organisations to pay subsidies to the other clinics.

The ministry has moved to limit to three a month the number of these casual visits a patient's home PHO is liable for, although the ministry will continue to reimburse the "casual" clinic with any subsidies due for additional visits.

Act Party health spokeswoman Heather Roy, who has been pushing for an education campaign, welcomed yesterday's announcement of one, but said it should have been started sooner. Few people knew how the system worked, she said.

Medical Association spokesman Dr Peter Foley agreed with the need for public education, saying it had to emphasise the obligations of patients as well as doctors.

Ministry spokesman Jim Primrose said it would have been pointless to start an education campaign last year when far fewer people were enrolled than now.

Primary health organisations

Umbrella groups for general practitioners and frontline health clinics, formed since July last year.

Government expects the organisations will reduce all patients' fees for primary care over the next decade.

More than 2 million people now covered by the organisations.

Fees for 1 million of them have been reduced.

Patients are asked to sign an enrolment form to join and have their medical records transferred to the clinic.

Many patients are provisionally enrolled, by being on the books of a GP who joins one of the organisations (at present there are 53).

Areas of poverty and high Maori or Pacific Island population have been targeted first, but even rich people in the primary health organisations in these areas receive the cheaper care.