Multiple Hawke's Bay health clinics are warning about the consequences of underfunding. Image / Rachel Lochhead
Multiple Hawke's Bay health clinics are warning about the consequences of underfunding. Image / Rachel Lochhead
Hawke’s Bay clinics say a lack of Central Government funding will put more pressure on patients during a cost-of-living crisis.
Tōtara Health, which has clinics in Flaxmere and Hastings, has asked patients with debt to pay in advance for all services, while Taradale Medical Centre hastold the Government that services will need to be cut if more funding does not come.
Tōtara Health introduced its new pre-payment policy this week, which means patients who owe more than $20 cannot access any of the clinic’s services without prepaying.
“We are making this change to eliminate patient debt and enable us to continue to provide a service to our patients,” a notice on its website read.
“We are significantly underfunded by the Government for the work we do and we have reached a point where the underfunding is threatening the financial viability of our business.”
The letter revealed that patients owe more than $350,000 to Tōtara Health.
Howard Dickson, managing director, said the current government and previous government had underfunded general practice health services for years and pointed to a 2022 report from Australasian consulting firm Sapere.
The report identified a “serious deficiency” at the core of New Zealand’s health system where services with a higher than average proportion of people with high health needs were not funded adequately.
All general practices had long been underfunded and a VLCA practice (with low patient fees) like Totara Health was even more significantly underfunded,” Dickson said.
“The effect of the underfunding of Tōtara Health will be reduced access to services, which will in turn lead to poorer health outcomes for patients who have greater health needs on average and more pressure on hospital services. We can see the impact of this already.”
Tōtara Health patient Angela Haggerty said she agreed with the policy but found it difficult to understand how Tōtara Health had so much debt and questioned how it got so bad.
“What we are charged for an appointment at Tōtara Health is significantly less than my colleagues pay at their health centres,” Haggerty said.
She agreed that Tōtara Health needed more funding from the government but also recognised that the government had limited funds to allocate.
Totara Health said it was “significantly underfunded by the Government” when explaining its decision to make patients with debt pay in advance for all services. Left photo / Duncan Brown. Right photo / Paul Taylor
Louise Shambrook, business manager for Taradale Medical Centre, shared with Hawke’s Bay Today a Clause 14 notice, highlighting a risk to the ongoing sustainability of a GP service, she sent to multiple ministers and Te Whatu Ora Health NZ.
“We have no functional means to negotiate our funding arrangements and are severely restricted in our ability to cover new costs by increasing our consumer co-payments, especially during the cost-of-living crisis,” Shambrook wrote.
She called for urgent action to increase the uplift offer and wrote that her clinic would be forced to restructure and/or reduce its services.
She listed possible consequences including an end to the ‘free under 14′ and ‘Community Service Card’ schemes, delays in diagnosis for serious and life-threatening illnesses, delays in access to specialist care and more.
Health Hawke’s Bay strategic advisor Fiona Thomson said the PHO wanted to enable everyone, especially Māori and Pasifika, to feel empowered and achieve wellbeing.
“We are concerned that this impact will limit wellbeing for whānau because it will make visiting a GP or nurse consultant in general practice a lot tougher financially, creating a burden for everyone,” Thomson said.
“The inadequacy of the proposed increase in government funding to maintain the level of subsidy for consultations in general practice affects all Health Hawke’s Bay practices and the Hawke’s Bay people who access general practice services.”
She said Health Hawke’s Bay had advocated for a review of the funding alongside all other PHOs and the General Practice Leaders’ Forum for at least 10 years.
“The base capitation formula was developed over 20 years ago in the early 2000s and no longer reflects or supports a modern general practice service model or the shift in the demographic profile of our national population.”
The General Practice Owners Association of Aotearoa New Zealand (GenPro) deputy chair Stephanie Taylor said an increase of more than 10% was required just to stabilise practices and some independent research had recommended as much as a 27% increase.
She said a 20-day consultation period was under way, but the government could still make a compulsory variation.
“At the end of the day, even if we say no it is hard to say that it is a negotiation. It is more they can say that this is what it is,” Taylor said.
Primary care includes GPs, ambulances, pharmacies and services such as Plunket.
“Primary care gets less than 6% of the health spend, yet we deliver more than 90% of the care.”
James Pocock joined Hawke’s Bay Today in 2021 and writes breaking news and features, with a focus on the environment, local government and post-cyclone issues in the region. He has a keen interest in finding the bigger picture in research and making it more accessible to audiences. He lives in Napier. james.pocock@nzme.co.nz
