Some doctors slow to pass on subsidies

The Ministry of Health is disappointed by the relatively high fees some GPs are charging patients, despite big increases in state subsidies.

Previous Health Minister Annette King said before September's election that she was satisfied most of the new funding for primary health care was reaching patients and average fees being charged were reasonable.

But in a briefing paper to the new Government, issued yesterday, the ministry said: "There is concern that, after the roll-out of substantial additional funding, a number of providers are still charging fees that are a barrier to access for individuals and families."

This contrasts with the ministry's view in March, when it was "delighted to see GPs complying with Government policy to keep fees down", although "a few" practices were charging higher fees.

The Government is putting an extra $2.2 billion into primary care over seven years and plans eventually to provide universal subsidies.

GPs' charges are lower at Access-funded practices. Interim-funded practices on average charge $25 for adults under 25 or over 64, the subsidised adult age groups, and some charge up to $35.

Subsidies will be introduced for 45-to-64-year-olds next July and for the last group, 25-44s, in 2007.

Health Minister Pete Hodgson said last night that fees at practices linked to primary health organisations were low or had reduced significantly, but there had been some "ticket clipping on the way through" by doctors, some of which was justified by rising clinic costs.

While the Primary Health Care Strategy had been "substantially successful" at making care more affordable, "it's less than a total success".

The briefing paper's section on primary care fees focuses on low fees.

It says: "With nearly all Access PHOs and many other PHOs delivering services at the low fee levels envisaged, it is clear they are achievable with the new funding."

Victor Klap, chief executive of the Independent Practitioners Association Council, a GPs' group, took exception to this.

"I think the assumption ... that the funding levels will and should be able to achieve low-cost access is inconsistent with the position of the minister and ministry two to three years ago. I don't think it's realistic for them to be saying that."

He said the fees policy agreed between doctor groups and the state referred to low or reduced fees.

The paper also notes the big pay rises of doctors and nurses at public hospitals, the rising expectations of access to new treatments and drugs, growth in chronic illnesses, and the re-organisation and building programmes at several district health boards which it says could distract them from service delivery.

The ministry and Treasury are reviewing health funding to make the future funding path realistic on health objectives and affordable.