GP fees too high for cancer patients

From Head and Neck Cancer Survivors' Support Network

A head and neck cancer patient moving to Auckland after 40 years in Rotorua and Whangarei couldn’t believe her eyes when she saw the high GP fees nearly everywhere north of the bridge.

Maureen Jansen, Secretary of the Head and Neck Cancer Survivors’ Support Network, investigated the policies behind this disparity between provincial towns and Auckland. She found that New Zealanders over 13 need to be dying to qualify for free visits to the GP. Only adults who have a terminal condition receive free or low cost care in many parts of the country, not just in North Auckland.

Primary healthcare is thus well-nigh unaffordable in many areas in New Zealand, even for elderly patients with ongoing cancer needs. Unless their local clinic qualifies for the Very Low Cost Access Scheme, they will pay through the nose to see a GP, anywhere between $42 to $60.

What is the Very Low Cost Access Scheme? It is a government policy where Primary Health Organisations provide generous funding to GPs who have over 50% of patients with “high needs”. This means that areas with large pockets of lower income people get the funding whereas no clinic on Auckland’s North Shore for example qualifies.

In effect, a millionaire in Whangarei will pay about $17 to $20 to see a GP whereas a 70-year-old cancer patient with a Community Services Card (meaning a very low income) will pay nearly $60 in Silverdale.

She thought it was even more unfair that now expensive areas of Auckland like Onehunga qualify for the low-cost scheme, probably for historic reasons. A GP visit in Onehunga costs $17.

Clinics receive funding for terminal patients and for patients with two (not one) serious health issues. The latter will receive four well-subsidised appointments a year under the Care Plus scheme.

The Community Services Card is of very little use for primary care, providing only a small discount for after hours care.

There is some “flexibility” in the system. The cancer patient with serious long term side-effects but who does not qualify for Care Plus because she has only one condition, can ask for the four subsidised visits but they won’t be offered. Patients have told her that they find out about this through hearsay.

GP clinics also have access to a small pool of money through an SIA scheme to help people who need special help but once again, it is not advertised and must be asked for.

Elderly patients in most clinics in the Waitemata District Health Board’s area pay as much or nearly as much as a younger working adult. Jansen saw on the Ministry website that GP clinics get different capitation rates for different categories of patients. People of her age (70) are funded much higher than a 34-year-old for example. So why should she, as a superannuitant with little other money, four cancers under her belt and a Community Services Card have to pay the same fee?

The answer is that the capitation rate is per enrolled patient not per visit. On average, someone over 65 sees a GP many more times than a younger person, thereby using up the pool of money allocated for that age group. Ironically, those who avoid the GP suffer because others of their age visit him/her so often!

“It is ironic,” said Jansen, who advocates for other head and neck cancer patients, “that primary care providers are developing grand-looking medical centres with a range of services that only the better off and well-insured can access easily.”

She would like to push for more accessible services for cancer survivors who have ongoing issues with their mental and physical health.

For many retired people or cancer patients whose household is down to one income, neither medical insurance nor GP visits are truly affordable any more.

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