The Minister of Health has asked Primary Healthcare to reduce next year's spending growth by $25 million. What does this mean for the provision of primary healthcare for New Zealanders and are universal subsidies a luxury that cannot be sustained?
The previous Government progressively introduced subsidised healthcare for all New Zealanders, by region and age brackets initially. Finally by 2007 every New Zealander was entitled to a Government subsidy for healthcare regardless of age, ethnicity or socio-economic status. There was no recognition or special funding offered directly to high needs users.
The new regime also allowed certain eligible practices to join the Very Low Cost Access Scheme (VLCA) whereby additional state funding could be accessed by a practice (not individuals) but even lower fee costs were imposed as a condition of joining that scheme. The scheme was targeted at high needs users but research has shown that over half of those participants attending VLCA funded practices are not high needs patients. At this stage the Ministry of Health is not willing to extend this scheme so that funding reaches more high needs users.
The current Government has so far maintained this funding regime, but is it affordable and does it deliver sufficient healthcare to the right people?
The reality is that the current system means affluent patients can access relatively cheap healthcare. Further, if their doctor’s practice is participating in VLCA funding, charges to patients are limited to $16.50 per consultation. This means that a high needs, low income patient attending the same practice gets the same amount of Government subsidy as the wealthy patient.
With patient co-payments of $16.50 per consultation at VLCA practices, this equates to an hourly income of approximately $70 for the GP. Anyone who has recently engaged the services of any other professional or tradesperson recently will appreciate that that is an extremely low hourly rate.
It is presumed that middle to high income earners are willing to pay a fair market charge for good professional service, regardless of which profession they are dealing with. Why would this socio-economic group view the purchase of their medical care any differently? In fact, increasingly, upper income earners are taking out medical insurance to further safeguard themselves and their families as evidenced by Southern Cross’s membership of 840,000 and growing Given that primary medical services are now significantly cheaper for many than they were five years ago, does that mean that we expect a lower quality of care from our GPs? Certainly not.
The funding regime brought in by the previous Government was clearly laudable at the time. It has changed the financial side of general practice on many fronts, whether through the reduction of cost barriers to accessing primary care or the rise in incomes for GPs and the associated potential increase in value of their practices. Maintaining the current Primary Health Care Strategy funding would be a nice thought, but if the costs are spiralling annually and sufficient dollars in care are not reaching the right people, the time may have come to overhaul universal subsidies.
Targeting funding for middle income earners, particularly for those families with one income earner supporting a spouse and children, would need special thought. Arguably families falling into this group would view a return to historical charges as unpalatable. Perhaps a system aligned to the Working for Families tax credit system could target funding for that group? Clearly the elderly, children, adolescents and low income earners will surely always be viewed by any Government as groups needing more support from the public healthcare purse.