'Cheaper' doctors push up prices

By MARTIN JOHNSTON and REBECCA WALSH

Many people are paying more to see a doctor at clinics which have joined the Government's new "low cost" health plan.

A survey of fees shows that GPs in high-income areas who have joined the Primary Health Organisation scheme are generally charging patients more than doctors who have not signed up.

Health Ministry papers published yesterday also show that unsubsidised fees for patients aged over 64 rose by nearly 12 per cent in the months before the start of a state cash payment intended to reduce charges for the elderly.

The Medical Association, which represents doctors, has defended the increases, saying the new system has forced many medical practices to assess the true cost of providing care.

The information, the first on the PHO system, comes from a ministry survey in February of 1088 practices.

The ministry said the research showed PHOs - which allow doctors to claim bigger state subsidies in exchange for accepting new Government demands over patient care - had made GP visits more affordable for half the population.

The survey showed charges were lowest at clinics receiving higher subsidies - those on the Access PHO funding formula reserved for areas with high Maori or Pacific Island populations or widespread poverty.

But fees at "interim-funded" PHOs in higher-income areas were generally higher than those at clinics which were not in a PHO.

Fees were even higher for most categories of patients aged 6 to 17 - despite the Government saying last October that all those in this age group enrolled in PHOs would receive low-cost healthcare.

In July, it said an extra $47 million for interim-funded PHOs would help reduce the cost of doctor visits for those aged over 64.

The ministry said yesterday average fees for elderly people previously unsubsidised appeared to have risen by 11.7 per cent between February and July at Interim PHOs, once the subsidy was included. The average patient charge was now $24.65.

The ministry's chief adviser on general practice, Jim Primrose, said one explanation was that when PHO clinics notified future fees, they tended to review their current fee, putting it up before committing to it.

Dr Peter Foley, chairman of the GP council, believed there were a number of reasons people were paying slightly more to see a GP at an interim-funded practice.

PHO practices had to provide a greater range of services than those that weren't part of a PHO. They also had greater information technology requirements.

Dr Foley said practices joining PHOs had had a "business wake-up call" on the true cost of providing care. Many practices had probably been carrying costs "unwittingly".

"As we move to all practices joining PHOs over the next couple of years, those other practices will meet the same business reality."

Average GP fees

Adults without a community services card:

$17.20 at PHOs in poor areas.

$43 at PHOs in other areas.

$40.10 at non-PHO clinics.


Those aged 6 to 17 with a community services card:

* $7 at PHOs in poor areas.

* $18.50 at PHOs in other areas.

* $17.30 at non-PHO clinics.


Source: Survey in February commissioned by the Health Ministry.