Tauranga pharmacists say they support the call for urgent action on prescription co-payments in hopes of achieving better health outcomes for the region's vulnerable population.
Charlotte Schimanski , owner of Ranolf Pharmacy in Rotorua, submitted a paper to the Lakes District Health Board recently amid concerns inequity would worsen as the country grappled with the Covid-19 pandemic - a concern that Tauranga pharmacists share.
She states the co-payment, the $5 fee for prescription medication, is unfair and does nothing to create better health outcomes for all.
She believes there should be a targeted removal of that $5 payment which is paid at pharmacies then collected by the DHB.
Unichem Metro Bethlehem Pharmacy's owner, Steel Chin, said his understanding of the co-payment was he was meant to collect tax, but it was now being used as a tool to attract customers. "It is now an unfair market."
A Tauranga pharmacist, who wished not to be named, said he did not understand why he needed to charge customers a government tax to get medicine.
"It would be better if health wasn't intervened by the Government and money-based things then health outcomes would be more significant.
"Why are we tax collectors and not medicine health outcome managers?"
The pharmacist said he supported the removal of the co-payment because it meant it was fair on everyone.
"If people couldn't afford certain medicines, they just don't take them and it just exacerbates the problem further down the track in hospitals.
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"The cost is negligible compared to the cost downstream."
The Bay of Plenty District Health Board planning and funding acting general manager, Mike Agnew, said the board was unable to quantify the impact of the issue specifically in the Bay but did know it was a regularly reported issue.
"The DHB is working to achieve better health outcomes for our community and especially our vulnerable and high-needs populations and strongly supports ways to do this."
Agnew said the DHB was also looking to better understand the inequities related to co-payments that existed in vulnerable populations.
However, he agreed Covid-19 and the flow-on socio-economic impacts of the pandemic would most likely exacerbate the situation.
The NZ Health Survey 2018-19 estimated about 4 per cent of people did not pick up prescriptions due to cost and that this number was significantly higher for Māori at 11 per cent.
"The inability to afford co-payment could be for a number of personal financial reasons as a result of poverty and inequality. Job losses as a result of Covid-19 are also likely to become more of a contributing factor," Agnew said.
A Ministry of Health spokeswoman said equity was a key focus for the ministry and it acknowledged the financial impact Covid-19 was having on communities and businesses.
"This Government has invested significantly to reduce co-payments in other areas of primary healthcare."
The spokeswoman referenced the $30 million to support the Māori Covid-19 Response Action Plan.
Of this, $8m had been allocated to community outreach and support services tailored to regional needs of Māori. This funding is being implemented by DHBs through local Māori health and disability provider networks and includes services as necessary to remove barriers to access such as prescriptions or health services co-payments or travel.
In response to the paper submitted by Schimanski, a Lakes DHB spokeswoman said the board appreciated receiving the paper and acknowledged the significant social deprivation in the communities.
"Pharmacists can waive or discount these co-payments and have done so as a form of competition.
"Due to Commerce Act considerations, the DHB cannot be seen to be influencing commercial decisions made by individual businesses."
Schimanski said she understood the response but wanted action.
Rotorua Area Primary Health Services (RAPHS) chief executive Kirsten Stone said 7 per cent of local respondents to the National Patient Experience Survey said they had not picked up a prescription because of cost.
"RAPHS agrees that targeting of co-pay subsidy for prescription costs is an effective strategy to tackle inequity, especially for people with long-term conditions."
Pharmacies offering zero prescription fees was not a scalable model, Stone said, especially following the economic disruption of Covid-19.
"The harsh reality is that for some the low cost of $5 for a prescription is $5 too much."
What subsidies are already available?
In most New Zealand pharmacies, consumers make a contribution to the cost of the government-subsidised medicines they receive when they pay a prescription charge, normally $5.
This standard charge did not apply to children 13 or under and was the same amount for medicines not fully funded by Pharmac.
Pharmacies may charge for extra services such as medicines delivery or packaging.
Once patients had collected 20 new prescription items in a year they could get a prescription subsidy, which meant they did not have to pay any more prescription charges until February 1 the following year.
Community Services Cards and High Use Health Cards could also reduce the cost of prescriptions from providers without a Health Ministry, District Health Board or Primary Health Organisation contract.