How you can afford quality private Health Care

  1. Affording quality private Primary Health Care
  2. Affording quality private specialist/hospital Care

 

[1] How you can afford quality private Primary Health care


As this practice is committed to providing Primary Health Care to the highest standard to individuals and their families, we cannot compromise this goal by providing "supermarket medical care" such as prescriptions without seeing the patient, seeing multiple problems in a brief consultation managed symptomatically and "conveyor belt" consultations in order to generate enough income to have very low fees. If someone has a medical problem, there needs to be enough time and effort made to establish the cause and the best management. As an Independent, non-PHO practice, we receive none of the extra money directed to Primary Health by the government making our practice uneconomic (non-viable) for many years and without moving fees to match the low end of other practices' "casual fees" the practice is unsustainable.

Why are our fees higher than other GPs?
Answer: Actually, our total fees are much lower, if one includes all the subsidies [Capitation, Performance funding, Services to Improve Access funding, Zero Fees for <6 funding (<13 after 1st July 2015 and <14 after 1 Dec 2018), Care Plus, Palliative care, Health Promotion funding etc] given to PHOs, it is just that you are excluded from the government's additional funding for Primary Care because they insist on me joining and being controlled by a PHO. I therefore have to charge the total fee (less pre-existing GMS or ACC subsidies).

As the practice can no longer continue to act as a charity, we either had to close or increase our fees. We have chosen the later so our fees have risen from 1st Novemeber 2018 to be closer to "casual rates" with low fees only for very brief consultations (under 10 minutes) and standard consultations are now based on 20 minutes.

There are a number of options for those that find their unsubsidised fees too high:

  • Cheaper Care - The simplest option if a person doesn't wish to pay for high standard Primary Care is to find one of the alternative PHO funded Primary Care providers happy to provide cheaper services because they are highly subsidised (not because they accept lower incomes).

  • Community Cervices Card - There remains the option of obtaining a CSC if your income is low and/or you have dependants. To qualify, you need to be on a benefit or have a low income.  Find out more about your Eligibility on line, or see a copy of the WINZ community-services-card brochure, [or ring 0800 999 999].

  • Other Cards
    • - High Use Health Card (HUHC) If you have a condition which should be seen frequently (12 visits a year), see the Receptionist to sort out qualifying for a HUHC, which is not income tested.  Find out more from WINZ about a HUHC here, [or ring 0800 999 999].
    • - Pharmaceutical Subsidy Card Once you have paid 20 prescription items in a year, talk to your pharmacist about a Pharmaceutical Subsidy Card, which is not income tested.  Find out more from WINZ about the Pharmaceutical Subsidy Card here, [or ring 0800 999 999].

  • Disability Allowance - A Disability Allowance from WINZ reimburses your medical and pharmaceutical costs if you have a CSC and an on-going illness. Obtain an application from WINZ and make an appointment to have this confirmed by me. However, it is important to keep the reimbursed money aside (perhaps in a special account) to be able to pay on-going medical and pharmaceutical costs. See on line here or disability-assistance brochure. Please note that you will need this AND MEET THE CRITERIA to have subsidised Medical Alarm. The main criterion people do not meet is "the medical alarm is needed and directly related to your disability/personal health need". To see if you may not qualify (and save an unneccessary GP visit) please read the "Scenarios" on pages 3 and 4 of the Medical alarm assessment form.

  • Insurance - You may wish to add General Practice costs to your Medical Insurance, although you would find this was much more expensive than just paying the fees (unless your employer has a medical scheme).

  • Self Insurance - Insuring yourself makes economic sense. If the extra cost of GP cover in a commercial insurance is $50 per month, put aside just half of that ($25) in a savings account and then an unsubsidised (non-CSC holding) adult would be able to afford:
    • 3 full unsubsidised visits in a year (which most people wouldn't need), or
    • three brief visits (say for repeat prescriptions or single simple problems) and one full medical review, or
    • two minor operations.

  • Alternative Arrangements - Ask the receptionist about alternative financial arrangements (eg automatic payments).

  • Get seen early - Get problems seen early, rather than waiting until they take more time and money. Saving up problems can make it more expensive -see Short Consultations [2]

  • Prevent ill health - Eat well (more fresh fruit & veges and complex carbohydrates, and less salt, fat and refined carbohydrates) instead of wasting money on supplements, walk 30 minutes per day instead of driving, give up the smoking (you will be able to afford a lot more), keep the alcohol down to 1-2 standard drinks per day and deal with what is stressing you rather than worrying or masking it with nicotine (or other drugs) and you may find you don't get so sick!!

  • Short consultations [1] - There may well be times when a brief (and hence cheaper) consultation is appropriate, such as repeat prescriptions when everything is steady and stable, or quick follow-ups. Also if the Receptionist is informed about what is needed at the consultation, preparations can be made to safely minimise the length of the consultation and keep the cost down.

  • Short consultations [2] - Keep your consultation brief and to the point (don't save up problems) and it will be cheaper in the long run. GMS subsidies are paid at a standard rate regardless of the type or the timing of the service, so a longer consultation is much more expensive than two standard ones for children or those on a community Services Card.

  • Be realistic! - A visit to the garage for a tank of petrol, to the supermarket, to the hairdressers for a semi-permanent dye, the dentist, vet, accountant or lawyers will all cost far more than much more highly qualified GPs ask, and those services won't save your life! In many similar overseas countries you could expect to pay about 4.5% of the average household monthly income to see a GP. As the New Zealand average household monthly income is $7,823, a visit to the GP should be $352 ! Instead we are charging approx. 1%. It is little wonder our graduates head off overseas and don't come back!

  • Get political! - If you don't have a CSC yet are not well off, particularly if you are over 65 or 18-24, the only reason you are denied increased medical subsidies from the government is because you visit an Independent GP. Your Practice Nurse also receives a tiny subsidy compared to nurses in PHOs and if you have an adult CSC, it hasn't increased for 16 years! The inability to have these subsidies is unjustifiable and no politician has been able to explain the real reason (which is to control GPs), it is nothing to do with quality of service as demonstrated by none other than the ex-Prime Minister's husband co-authored 2001/2 report (only released in 2004) Primary Health Care in NZ.
    You may wish to contact your Member of Parliament to see if he will ask the Minister of Health why a tiny amount of the extra $millions given to Primary Care cannot go towards increassing the GMS to allow non-PHO GPs and A&M clinics to reduce their fees.
    See a fuller description of GP visit subsidies at the MoH GP Visits page.

  • Don't pay! - Not paying for our GP services is just not acceptable, just like driving away from a service station without paying for the petrol you have pumped. It is not only illegal, it has not the slightest ethical justification when the GP isn't earning a "living wage". There are affordable practices if you cannot use one of the other suggestions above to support your costs attending this practice which can no longer afford to subsidise patient fees.

Also see the Fee Schedule page


 

[1] How you can afford quality private specialist/hospital care

  • Private Insurance - If the cost of full Health Insurance is an issue, restricting yourself to a plan that only covers specialists and private hospitals could be a sensible option.

  • Life Loan - Many retired people are asset rich (mortgage free home) but income poor (dependent on Superannuation). It is now possible to obtain a loan which doesn't have to be repaid until death or on selling the home. This ability to obtain funding can make a huge difference in one's quality of life. The only "down-side" is that you will leave slightly less inheritance to your children, but it is your money, not theirs, and so it should be you who should enjoy the "fruits of your lifetime of labour and saving". Children should not expect a financial inheritance, you have hopefully raised them to be independent productive members of society who can make their own money and have no wish to deprive you of good health.

  • Insure Yourself - If you have a mortgage you may be able to arrange a "revolving credit" option whereby you can access money as you need it for private specialist investigations and surgery. If you don't need to have private care, your "premium" goes to paying off your mortgage. If you have a freehold house you may find a scheme where you can access that equity when needed. Your children shouldn't care if you have less equity in your house when you die and unless there are significant political changes, it could be to your advantage to have less equity when you need rest-home care!

  • Use the private system selectively and intelligently - Quite often the public "bottle-neck" is the outpatient assessment. A "smart" way around this is to go privately for the specialist assessment and then be referred to the public system for treatment. Another "smart" approach is confirming a diagnosis by a private investigation (eg Ultra-sound scan, colonoscopy, biopsy) ensuring appropriate priority in the public system, e.g. confirming a cancer diagnosis ensures an urgent priority, instead of a routine or semi-urgent one with just a suspected diagnosis. Some may consider these to be "queue jumping" methods, but in reality it is taking pressure off the public assessment list (so others are seen earlier) and you are still prioritised for treatment according to need.

  • Get your priorities right - Decide if obtaining timely, high quality medical/surgical care is required for you to maintain your quality or even quantity of life, and if so, is it more important than a new car, an overseas trip or leaving money to your children (who should be able to earn their own if you raised them right). If you had access to the money but hoped to get specialist care free in the public sector, there is only one person to blame if your health suffers waiting on a rationed public system. On reconsideration, the "I can't afford private specialist care" may become "I can't not afford private specialist care".

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