Many people are deterred from seeking medical help because of the fees charged by general practitioners, a survey has found.
For a decade, New Zealand Governments have ploughed increasing subsidies into primary health care with the aim of reducing the cost barrier, treating more people in the community and keeping people out of hospital.
Yet a Herald-DigiPoll survey found nearly a third of adults had avoided seeing a GP in the past year because of the cost - a finding that is worrying to GPs.
"I would have expected it to be nowhere near as high," said Dr John Cameron, a Westmere GP and clinical director of the ProCare primary healthcare group.
He said there were risks in delaying a visit to a GP. "You become more unwell, you need more expensive care - you may or may not require expensive hospital-based care."
GPs were ethically obliged to care for their patients even if they couldn't pay, Dr Cameron said.
He urged patients who had been deterred by fees to try to come to an arrangement with their doctor, possibly a direct credit of a small weekly sum. Some of his patients paid $2.50 a week in this way.
General Practice Leaders Forum chairman Dr Tim Malloy said the DigiPoll finding was "disconcerting". It was probably linked to the recession causing some to view spending on GP visits as discretionary.
GPs' fees vary widely. A number of clinics - mainly in wealthier parts of Auckland - charge adults more than $50. The advertised charge at the Onewa Road Doctors Surgery in Birkenhead is $58 for adults aged 25 to 64.
Many clinics, however, are contractually locked into a maximum fee of $17 for adults, $11.50 for children aged 6 to 17, and no charge for children under 6 - in return for higher rates of Government subsidies for each patient on their roll.
The Health Ministry says the average patient charge is $30.34 for adults having a non-accident-related consultation.
The ministry says the DigiPoll findings cannot be compared with its own surveys.
It cited an international survey from 2010 by the Commonwealth Fund which found 9 per cent of New Zealanders reported that, because of the cost, they had not visited a doctor in the past year when they had a medical problem.
In Australia the figure was 13 per cent, and in the United States, 22 per cent.
Health Minister Tony Ryall said his Government had increased GP-visit subsidies every year since coming to office in 2008.
Its contribution had risen by 27 per cent to $786 million this financial year from $621 million in 2007/8.
Some 340,000 children under the age of 6 - about 90 per cent of children of that age - now get free doctor's visits during the day and most of them also have access to free after-hours GP care.
The Labour Party's health spokeswoman, Maryan Street, said the expansion of free care for children under 6 had been uneven because GP participation was optional.
"There are parts of the country where there is no pick-up at all."
She said that with adult fees more than $50 in some areas, "there needs to be a substantial reconsideration of the capitation grant, the subsidy to GPs".
Financial pain keeps dental patients away
A survey finding that a majority of adults have avoided dental care in the past year because of the cost has prompted calls for subsidies like those for GPs' patients.
Basic dental care is free to patients and state-funded for those aged under 18, but for adults, the Government pays only for emergency care.
On average, an examination and basic x-ray cost $97 in 2010, according to the Dental Association's latest published fee survey. An amalgam filling involving one tooth surface cost an average $134 nationally.
Anti-poverty campaigner Sue Bradford, a former Green MP, said she was not surprised by the findings of the Herald-DigiPoll survey because she was well aware of the extent of people being unable to afford dental care.
"People often don't think about it until they are in terrible pain or sick. I think there should be state involvement in trying to bring dental costs down."
Labour's health spokeswoman Maryan Street reiterated her party's oral health policy from last year's election, which included the promise to extend as resources allowed the provision of affordable dental care "beginning with pregnant women receiving a package of free dental services".
Dental association executive director Dr David Crum said the higher avoidance rate for dental care than GP care shown in the poll reflected the lack of GP-style dental subsidies - "and the lesser importance [people] attach to oral health than to general health".
Asked if dentists charged too much, he said, "No. There are huge demands on dentists to provide quality work - and that costs."
Health Minister Tony Ryall said a general dental subsidy would be "completely unaffordable" in today's financial climate.