Money, money, money! Abba sang about it and the musical Cabaret told us that it makes the world go round. Not surprisingly it has a big impact on health.
Fundamentally, even in New Zealand, the richer you are the longer you are likely to live and the better your access will be to health care. And the impact is particularly significant on children.
Successive governments since the 1930s have attempted to remedy this. Public hospitals became free in 1939 and GP visits were first subsidised in 1941. Initially the payment was seven shillings and sixpence, about the cost of a standard consultation, but it stayed the same for 30 years, having risen to the princely sum of $1.25 when I entered general practice.
This GMS (general medical services) subsidy was a bureaucratic nightmare with about 12 million claims made manually every year, every one of which had to be checked by longsuffering clerical staff in the Ministry of Health.
The big change was in 2001 when capitation was introduced. Patients are not always aware that their doctor now receives a monthly payment from the government per enrolled patient, rather than per consultation. This is why enrolment with a GP is so important. Without it the fees are often totally unsubsidised, accounting for the higher charges when consulting as a casual patient or attending an Accident and Medical centre. This monthly payment gives the GP some flexibility in how to allocate the funds, for instance in providing preventive health advice, telephone and email services, population health promotion and so on. GP’s set their own consulting fees so there is a reasonable amount of variation but we do try to balance the need to run a business and serve our communities.
In areas of socio-economic deprivation there are extra subsidy levels but this doesn’t apply anywhere on the Hibiscus Coast.
In addition, there are some targeted subsidies for youth health, high needs and frequent users. WINZ can help with medical costs in certain circumstances and it is worth asking your doctor about this.
As a side issue, patients often ask why ACC consultations are not free. The ACC system sits alongside capitation funding and has not kept up with inflation, leaving a gap that is patient-funded to about the same level as an ordinary consultation.
We can’t go back to the 30’s and 40’s but I believe the Government is trying hard to remove financial barriers for those who need it most.