KEY POINTS:
Doctors' fees for adults aged 25 to 44 have almost halved this week after the final stage of the Government's primary health-care funding policy took effect last Sunday.
A Weekend Herald survey of 109 health centres, excluding low-fee "access" clinics, has found that the average fee for a standard 10- to 15-minute consultation has dropped from $57.43 last week to $30.67.
The average fee reduction of $26.76 was very close to the cut of $27.50 required by the Government to qualify for increased funding from July 1.
The reductions ranged from only $16 at three already-low-cost clinics up to $36.50 at two Auckland clinics that charged $52 but have adopted the highest funding regime where their fees are capped at a maximum of $15.50.
Almost 1 million people, or 24.4 per cent of the population, are now enrolled with doctors who have joined this "very low-cost access" regime.
The director of Victoria University's Health Services Research Centre, Dr Jackie Cumming, said the gradual lowering of fees, which has added $2.2 billion to health subsidies since 2001, appeared to be encouraging people to go to the doctor sooner and more often than in the past.
Figures will not be available until her centre publishes a report in the next two months, but she said feedback from doctors pointed to a "reasonably significant" increase in patient visits.
"There have been comments about increasing workloads and seeing people more often," Dr Cumming said. "It's not clear to me how the increased utilisation has been undertaken. It's quite possible there are more nursing services being delivered or more use of other community health workers."
But Napier doctor Mark Peterson, who chairs the Medical Association's General Practitioner Council, said doctors reported bigger increases in patient visits in middle-class areas than in the low-income areas where the subsidies were increased first.
"I'm not sure whether we have got the targeting right," he said.
"The issue is not just funding and costs to get people with higher health needs to see their GP more often, rather than going to the emergency department of a hospital or being admitted to hospital because they ignore their conditions for too long.
"It's also transport, for example. Sometimes it's bad debts - if they have a bad debt with the doctor they won't go.
"It's also cultural issues - some cultures see health as aligned with hospitals so don't use their GP."
This week's final step in the subsidy programme means doctors are now funded at the same rate for all adults whether they are millionaires or paupers, provided that they are enrolled as their patients.
The cost of subsidised prescriptions has also dropped to a standard $3 per item.
The community services card, which used to carry a $15 subsidy, has become redundant except when patients go to someone other than their regular doctor, such as an after-hours accident and emergency clinic.
The quid pro quo for GPs who have accepted the higher subsidies is that they now need district health board approval to increase their fees beyond standard guidelines, which currently allow increases of 5 to 6 per cent a year.
To qualify for the increased funding this week, they had to cut their fees by either $27.50 for the 25 to 44 age group, by $27.50 in total across all adult age groups, by at least 55 per cent, or to $22.50 or less.
Review committees have to take account of 14 criteria before approving or rejecting fee increases, including fees charged at nearby practices.
But Dr Peterson said doctors were still allowed to take account of local "demographics".
- additional reporting: Beth Allen, Jarrod Booker, Derek Cheng, Simon O'Rourke and Juliet Rowan
Even PHO doesn't know one practice's charges
The most expensive place in New Zealand to go to the doctor may be the Hobsonville Medical Centre - but then again, it may not be.
The busy West Auckland clinic, in a new housing area near the former Hobsonville Air Force base, stated a fee of $82 for adults aged 25 to 44 on the website of its primary health organisation, HealthWest, until last Saturday - by far the highest in the country.
When the Weekend Herald visited on Thursday, the figure had been crossed out and replaced in handwriting by "$25.64-$55.22".
The top rate is $10.22 more than the next-highest in our survey - $45 at the Selwyn Medical Centre, in well-off Kohimarama.
The two Hobsonville doctors, Dr Peter Moore and Dr Sue Clark, declined to speak to the Herald, but HealthWest officials said they would not be surprised if some patients paid higher fees at the clinic than anywhere else.
HealthWest chairman Dr Clive Stone said Dr Moore came from an Air Force background and "has never been part of the established family practice in the sense that most GPs would relate to it".
"We are dealing with a practice that believes general practitioners should be very well paid, that we do very important work, that we have lots of skills," he said.
"He [Dr Moore] will say we represent the top 1 per cent of the total intellect of the country and we are poorly remunerated for the sort of work and obligations that we have."
He said Dr Moore's fees were "not governed by any rule of logic".
"We can't draw any conclusion as to what he does actually charge.
"You would have to stand outside his surgery and collar everyone as they come out to find out what they have been charged."
