A local pharmacist is calling for urgent action on prescription co-payments in the hope that it will achieve better health outcomes for Rotorua's vulnerable population.
Charlotte Schimanski , the owner of Ranolf Pharmacy, recently submitted a paper to the Lakes District Health Board amid concerns that inequity would worsen as the country grappled with the Covid-19 crisis.
She stated the co-payment, the $5 fee for prescription medication, was unfair and did nothing to create better health outcomes for all.
"In Rotorua, we have a vulnerable community, we are one of the most deprived regions in the country and that $5 prescription payment is a huge barrier to people collecting their medication."
Schimanski said the median income in Rotorua was $26,900 which signalled to her that the fee was "quite a significant chunk of that income". And with the consequences of the pandemic, she feared more people would not be able to afford their prescriptions.
"I think there should be targeted removal of that $5 payment.
"It is so heartbreaking on a daily basis. People feel like they have to choose what medicines they should take but it shouldn't be something that people have to consider."
The fee, paid at pharmacies for the prescription, is then collected by the DHB. In that regard, Schimanski said she felt like a tax collector for an unfair system.
In response to the paper submitted by Schimanski, a Lakes DHB spokeswoman said the board appreciated receiving the paper and acknowledged the significant social deprivation in the communities.
"Pharmacists can waive or discount these co-payments and have done so as a form of competition.
"Due to Commerce Act considerations, the DHB cannot be seen to be influencing commercial decisions made by individual businesses as this will contravene the Act."
Schimanski said she understood the response, but wanted action.
"Cost shouldn't be a barrier. We want people to have equitable access to health care so let's do something about it."
The Lakes District Health Board serves 110,410 people and its Community Pharmacy Strategic Plan 2018-2025 says many residents "struggle with the cost of doctors visits, the cost of medicines and transport to reach a health centre.
Rotorua Area Primary Health Services (RAPHS) chief executive Kirsten Stone said 7 per cent of local respondents to the National Patient Experience Survey said they had not picked up a prescription because of cost and 40 per cent of all people enrolled with one of RAPHS member general practices lived in deprivation quintile five.
"RAPHS agrees that targeting of co-pay subsidy for prescription costs is an effective strategy to tackle inequity, especially for people with long term conditions."
Pharmacies offering zero prescription fees was not a scalable model, Stone said, especially following the economic disruption of Covid-19.
"A targeted co-pay subsidy for Community Service Card holders would be a good idea and sensible investment for the health system from a cost-benefit perspective.
"The harsh reality is that for some the low cost of $5 for a prescription is $5 too much to be affordable."
The Bay of Plenty District Health Board planning and funding acting general manager Mike Agnew said the DHB was unable to quantify the impact of the issue specifically in the Bay but did know it was regularly reported as an issue.
"The DHB is working to achieve better health outcomes for our community and especially our vulnerable and high needs populations and strongly supports ways to do this."
However, he agreed that Covid-19 and the flow on socio-economic impacts of the pandemic would most likely "exacerbate" the situation.
A Ministry of Health spokeswoman said equity was a key focus for the ministry and it acknowledged the financial impact that Covid-19 was having on communities and businesses.
"This Government has invested significantly to reduce co-payments in other areas of primary health care."
Specifically to co-payments, the spokeswoman referenced the $30m to support the Māori Covid-19 Response Action Plan.
Of this, $8 million had been allocated for community outreach and support services tailored to regional needs of Māori. This funding is being implemented by DHB's through their local Māori health and disability provider networks and include services as necessary to remove barriers to access such as prescriptions or health services co-payments or travel.
What subsidies are available?
In most New Zealand pharmacies, consumers make a contribution to the cost of the Government-subsidised medicines they receive when they pay a prescription charge, normally $5.
This standard charge does not apply to children 13 or under and was the same amount for medicines not fully funded by Pharmac.
Pharmacies may charge for extra services such as medicines delivery or packaging.
Once patients had collected 20 new prescription items in a year they could get a prescription subsidy, which meant they did not have to pay any more prescription charges until February 1 the following year.
Community Services Cards and High Use Health Cards could also reduce the cost of prescriptions from providers without a Health Ministry, District Health Board or Primary Health Organisation contract.