GP costs drop for young adults

The average cost of visiting the doctor has dropped to around $25 on average for hundreds of thousands of patients as the Government moves towards offering subsidies for all.

The latest age group to benefit was 18 to 24-year-olds in numerous primary health organisations (PHOs) from July 1, following over-64s last year.

Fees vary widely, but have dropped from around $50 to $25 on average for these age groups after the new universal subsidies were introduced at PHOs to replace the low-income-targeted community services card. Prescription charges have also been reduced.

The Government is spending $1.7 billion of new money through the bulk-funded PHOs over six years to reduce primary healthcare fees.

It does not set patients' fees - doctors have always fought to retain that right - and it highlighted a 12 per cent rise in fees for many elderly people ahead of their new subsidies. It demanded the bulk of the funding reach patients.

GPs said the big fee rises were because the new system forced them to assess their true costs.

Health Minister Annette King said she was now satisfied most of the funding was reaching patients and that $25, as an average fee, was reasonable.

The so-called "access" PHOs - in areas of poverty and high Maori and Pacific population - are funded to subsidise all patients, but at "interim-funded" organisations subsidies will not be available for adults aged 45 to 64 until next July and for 25-to-44-year-olds in 2007.

The latest new funding was for young adults enrolled at practices aligned with interim-funded PHOs - which serve the less-deprived and more-Pakeha areas. The subsidies are estimated at $26.75 a visit and on average clinics are passing on $25 to each patient who visits.

But some that wanted to pass on less than $23 have been excluded, so their young-adult patients will continue to face full fees, unless they have a community services card or qualify for some other discount.

All PHOs now receive the same funding per patient aged 18 to 24, but interim practices charge on average $8 more a visit than access clinics. Similar disparities exist for other subsidised age groups.

"It's hard to justify such a discrepancy," said Consumers Institute chief executive David Russell.

Interim-funded clinics say it is because they make less use of nurses, whose pay is lower, and since they are not funded for all age groups they need to spread the risk that patients will visit more often once they realise it is cheaper.

"Only when they are access funded can they smooth the risk - i.e. manage the unders and overs in their pricing," said the Independent Practitioners Association Council's chief executive, Victor Klap.

The Health Ministry is considering offering incentive payments after 2007 to practices with lower fees, but believes some disparity is inevitable.

"We have always had a distribution of fees and we will continue to," said the chief adviser, general practice, Jim Primrose.

He said the sector also argued that GP consultations were longer at interim practices than at access ones - but a pre-PHO study found the average was 15 minutes whether at a not-for-profit health centre or a privately run medical practice.

The ministry and Consumers Institute want practices to be more open about their fees, advertising them or publishing them on websites. Several have listed their fees on websites, although PHO practices are contractually obliged to display them where patients can see them, such as on clinic walls.

Average GP fees

* $16.58: For 18 to 24-year-olds enrolled at primary health organisations (PHOs) in many areas of poverty and high Maori and Pacific population.

* $24.63: For 18 to 24-year-olds at PHOs in other areas.

* $1.45: For children under 6 in PHOs.

* $50: For unsubsidised GP visits by adults - up from $34 in 1999.

Source: Ministry of Health