First year of PHOs produces mixed response

Organisations set up to implement the Government's primary healthcare strategy are divided on whether lower doctors' fees encourage more people to see doctors.

Under the strategy, primary health organisations (PHOs) made up of GPs and other health providers were set up in many areas.

The strategy puts greater emphasis on community-based health services working together to reduce the number of people in expensive, hospital-based treatment.

Victoria University's health services research centre yesterday published a report looking at the first year of PHO operation.

The study included questionnaires and interviews with key personnel in 21 of the 34 PHOs established by April this year.

Of those involved in the study, 16 were totally funded under the more highly subsidised Access scheme, while four of the other five had some practices covered by the higher subsidy.

Research centre director Jackie Cumming said all Access-funded PHOs had reduced the price of GP visits.

But the effect of lower fees was not clear.

The research also found a wide range of new services was being provided or planned under the PHO model, she said.

Health Minister Annette King has said that PHO charges would vary but those funded by Access should be able to offer free care for children under 6, school-age children would generally be charged less than $10, and most adults would pay an average of $15 and no more than $22.

For now, Access funding goes to those PHOs in poorer areas or those with high health needs, including areas with large Maori and Pacific Island populations.

But from October 1, all 6- to 17-year-olds enrolled in PHOs were funded for low-cost healthcare. The same will apply to over-65s from next July.

A quarter of the population now had access to low-cost primary healthcare, and more than two million people were serviced by the 53 present PHOs.

Ms Cumming said the primary health organisations strongly backed the philosophy behind the primary care strategy, but criticised its implementation.

"There is a lot of goodwill present within the sector, and a willingness to 'make it work' to achieve health gains for everyone.

"But, despite the support from district health boards, PHO staff reported that the process of establishing the first PHOs required an enormous investment of time, personnel and resources.

"They felt that establishment funding was often inadequate and late and that costs were often masked as much work and time was provided voluntarily and without reimbursement."

Those interviewed felt a lack of public understanding about their organisations. A big educational process was needed, particularly in populations that were hard to engage because of literacy, language and cultural issues, Ms Cumming said.

Director-General of Health Karen Poutasi said the Health Ministry and district health boards had addressed a significant number of concerns in the report.

"The primary healthcare sector in New Zealand is going through the biggest change since World War II and it is inevitable that in the very first year of implementing this change there will be difficulties."

What PHOs are

* Umbrella groups for general practitioners and frontline health clinics, formed since July last year.

* More than 2 million people now covered by the organisations.

* Fees for 1 million of them have been reduced.

* Areas of poverty and high Maori or Pacific Island population have been targeted first, but even rich people in the primary health organisations in these areas receive the cheaper care.

- NZPA