Gap in plan to target cheap doctor visits

By ANNE BESTON

The cost of visiting the doctor could vary under new proposals, depending on whether the majority of the doctor's patients are poor, Maori or Pacific Islanders.

Doctors are worried that wealthier people will migrate to medical centres with a high proportion of low-income people.

A confidential draft document, widely circulated for comment to medical organisations and obtained by the Herald, sets out how the Government intends to make sure cheaper healthcare goes to those who most need it: Maori, Pacific Islanders and people on low incomes or with a Community Services Card.

Under changes described as a "revolution in primary healthcare", the Government proposes to use medical practices to feed the money through the system rather than subsidising individual patients as the Community Card does now.

The scheme is expected to cut costs for 300,000 people.

Under the proposals, primary health organisations (PHOs) will have to prove to District Health Boards that at least half their enrolled patients are Maori, Pacific Islanders or people who otherwise qualify for higher health subsidies for one reason or another.

If they do, they get a bigger slice of the $410 million the Government earmarked this year to get cheaper primary healthcare to low-income and high healthcare users such superannuitants or Maori and Pacific Islanders on a benefit.

But all patients registered with the medical centre will get the subsidy, regardless of whether they are in the target group.

Conversely, if a practice does not qualify for the subsidy, none of its patients will get the cheaper doctor's fees even if some are in the target group.

While the Community Card will iron out the inequities to begin with, the Government is phasing out the card over the next 10 years.

New Zealand Medical Association chairman Dr John Adams would not comment on specific proposals in the document because it was confidential, but said his group had made its concerns clear to Health Minister Annette King.

The Government's intentions were "laudable", he said, but doctors saw problems ahead.

"If a PHO gets the increased money and therefore their patients have lower-cost access to healthcare, what is going to happen in the neighbouring practice. Is there going to be a migration of patients?"

GPs have already begun setting up organisations to fit the new system. About 80 per cent already work together in Independent Practitioner Associations, which are expected to develop into PHOs.

Joining a PHO will be voluntary but it could be difficult for practitioners to refuse to join because financing will be based on it.

Dr Paul McCormack, chairman of the Independent Practitioners Association Committee, said New Zealand was about to undergo a "revolution" in primary healthcare and his organisation had met ministerial officials last week to discuss the new system.

He was keen for those discussions to continue and did not want to get into a debate in the media.

But the Government's focus on preventative healthcare and targeting doctors' organisations rather than hospitals was the right one - "It's the fence at the top of the cliff."

Dr Adams said one of the biggest concerns was whether the money, staggered over 10 years, would continue as the Government promised.

If it did not, GPs would be left with a revamped structure but not the extra money.

The $410 million is part of the $2.4 billion extra for health announced at the end of last year.

Next year a further $165 million will be put towards cutting costs for schoolchildren and the elderly visiting GPs or medical centres. An extra $195 million will be spent in 2004-05.

Mrs King said that while there were some issues "around the edges" of the new system, she believed getting good primary healthcare to people was top priority.

"For instance, if you look at Auckland you will find the first funding will go into South Auckland.

"I can't imagine people from the city will drive down to South Auckland to save themselves a few dollars."

She and her officials were working through concerns with interested organisations but she believed there would be fewer problems than some people thought.