Elderly baulk over doctor fee of $170

Elderly Northlanders could be going without vital medical attention because after-hours doctors' call-outs can cost $170.
Concerns are growing that rest-home residents in particular are avoiding calling doctors in acute, after-hours medical situations.
Private clinic White Cross, which covers emergency duties for all Whangarei doctors, has recently increased its after-hours call-out fee to rest-homes to $170.
The fee rise could be responsible for a marked rise in the number of rest-home residents treated at Whangarei Hospital's emergency department over the holiday period. At the time department head Dr Scott Cameron said many of those patients had conditions that should have received earlier medical attention.
Most Whangarei rest-homes have contracts with general practitioners to provide care for residents, but that contract price does not extend to after hours. White Cross is contracted by the PHO to provide those after-hours services.
Rest-homes often pay the full tab for their subsidised residents' after-hours medical attention, although they are not obliged to pay the full amount. Privately funded residents meet the whole cost of medical care themselves.
Beth Kelly, manager of Merrivale Rest-home at Kamo, said many in the sector considered the after-hours fee "exorbitant". "We've got concerns, particularly around the holiday period. We've written to the DHB and the PHO and are awaiting a response," Ms Kelly said.
Meanwhile, the increase of patients seeing emergency department staff rather than general practitioners has blurred the lines between private and public health care and who pays.
District Health Board chief executive Karen Roach said the number of rest-home residents going to the emergency department had signalled there was a problem regarding a certain sectors' access to medical treatment. "We need to assess the situation and see just how much of an issue this is."
Part of the capitation funding Manaia Primary Health Organisation received from Northland District Health Board was for doctors' services, including emergency call-outs, she said. The DHB was keen to hold talks with the other parties regarding White Cross's high fees. In the meantime the DHB had little direct influence on a private service's charges. "White Cross, as a private organisation, can charge what it likes but they are the only (after-hours) provider, so have a monopoly." The DHB would support studying ways its clinical staff could be involved in assessing rest-home processes, nursing skill levels and call-out criteria, she said.
White Cross manager Jackie Westcott said that while the charge had risen to a general $170 for after-hours call-outs, some doctors applied some "flexibility". The amount the doctor received from each call-out fee was $80.
"The costs of after-hours care has doubled over the past few years. We've tried to absorb those costs," she said of the fees hike.
Chris Farrelly, chief executive of Manaia PHO, which represents patients and doctors, said he agreed an issue that denied any sector access to health care needed investigating. "Say it's a legitimate charge," he said of the $170 fee. "There's still the issue people who need the service can't pay for it."
Whangarei Age Concern president and manager Beryl Wilkinson said the organisation was concerned. "Older people are vulnerable. They need to have confidence there is affordable health care out there. But it's not just the elderly who need to know that," she said.
* BILL BITES
The daughter of one Whangarei rest-home resident was "flabbergasted" when her mother, 74, was hit with a $170 bill when a doctor was called to her after hours by nursing staff.
Previously, the same service had incurred a bill of $85, Selina Neighbour said.
"I thought it was a terrible price then," Ms Neighbour said. "My mother gets $62 a fortnight for personal and health costs after her being in rest-home is paid for. It would take her six weeks to save all of that to pay the doctor's bill."
Her mother's bill ended up being largely covered by the rest-home, Mrs Neighbour said. However, the facility was under no obligation to have paid the greater amount.
"These people have paid taxes all their lives. They are entitled to be looked after and that includes getting affordable medical care," she said.
* Have your say
What do you think about doctors charging $170 for an after-hours visit to a rest-home resident?
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