Wednesday, 10 September 2014

A Policy A Day: Free GP Visits

In the lead-up to the election, we are going to examine one policy per (working) day. We've selected policies to be as balanced as possible across a range of policy areas and across the political parties. The idea is to explain the background, analyse the policy to investigate the pros and cons, and give a verdict on the policy at the end. Inevitably, some opinion will make its way in and we make no apology for that - after all, we're voters too. Also, I say 'we' because this series will feature some guest posts from other young people, to share their thoughts and ideas as well. A list of all the articles is available hereEnjoy!

At the moment in New Zealand, free GP visits are available for those under the age of 6. Today's policy comes from a variety of parties, each who have policies to change the status quo for "free GP visits". Free GP visits usually also includes free prescriptions, and in the case of the Greens free transport to the GP as well.
- The National Party has pledged to make GP visits free for everyone up to the age of 13.
- The Labour Party wants to make GP visits free for everyone up to 13, over 65, or pregnant.
- The Green Party wants to make GP visits free for everyone under the age of 18.
- The Maori Party endorses the National Party policy to make GP visits free for everyone up to 13.
- United Future endorses the Labour Party policy to make GP visits free for everyone over 65.
- New Zealand First accuses National of "pilfer[ing]" their policy.
- The ACT Party wants to abolish health co-payments in general and has called National's promise of extending free GP visits to 13 an "election bribe".

Background
Before we go too much further, "free GP visits" means that private practices opt-in to the system - there are some practices around the country that can continue to charge whatever they want (although they may get less government subsidy). The NZ Herald reports that "Of the 1029 general practices nationwide, 1004 practices had opted into the free under-sixes scheme and subsequently 98 per cent of children under six can go to the doctor for free." Some private practices do find other ways to add surcharges - the Ministry of Health only says that "fees for children under 6 are usually lower [than fees for adults]", just short of categorically stating that all GP visits for children under 6 are free.

Beyond this, there is often confusion about the cost of visiting a GP - the government subsidises GP visits already (if you are enrolled with that GP for the purposes of District Health Board funding (this is where Primary Health Organisations (PHOs) come into the equation)), but after the government subsidy the GP can add a surchage up to a maximum value. This has caused the cost of GP visits for children (up to age 18) across the country to vary between free and $70, with an average cost of $21, although the cost is often higher for after-hours visits. This uncertainty is confusing for parents, and perhaps a free policy would help make things clearer for everyone.

Analysis of the Policy
When it comes to health, it is something that is critical to all human beings yet something that we often cannot control or expect. Increasing the age from 6 to 13 is a natural progression that makes sense if the government has found a way to fund it. The success of the policy will still be dependent on the number of doctors that opt-in to the programme - if the level of government subsidy does not sufficiently cover the current costs of private practices, then they may opt-out and continue to extract their funding from their customers (patients). The free visits for under 6 programme has supposedly been provided by many practices at reduced income for practitioners, but offered anyway to achieve social good. Both the Medical Association (representing family doctors) and the Rural General Practice Network have cautiously supported the policy to cover all those up to 13, but need to see what level of subsidy the government will offer before they go further.

One of the most important reasons for these policies is the fact that there are young people who suffer from preventable illnesses due to an inability to afford the GP visit. There are continuing health inequalities that are both a cause and effect of continuing poverty in this country. The Child Poverty Action Group (CPAG) says "For a household simply “getting by” week-to-week, there is unlikely to be a spare $24 available for an unexpected trip to the GP in-hours, let alone $44 after-hours." The result is that the Ministry of Health reported that 44,000 sick or injured children failed to see a doctor in 2012 due to the cost. There are long-term consequences for delaying medical treatment; complications can lead to lifelong medical conditions, but a family that cannot afford the GP visit is more likely to delay seeking medical attention until the situation is already too late. Dr Nikki Turner sums the problem up with "Kids shouldn't be kept caught in the middle... kids can't chose if they have money or not." As well as free GP visits up to 18, the Green Party also proposes standardised surchages on medical fees as an alternative solution, just to provide certainty across the country.

The government also has an interest in reducing the number of emergency room visits (and thus reduce congestion in that system) by encouraging individuals to go to the GP first. The strain on our hospital system is a continuing struggle; the situation is better than it was ten years ago and has been improving, but some pressure could be alleviated by getting low-risk cases seen by GPs. This does lead to one concern with the policy proposals - in most cases, an increase in GP visits has not necessarily been taken into account. That is likely to increase the cost of implementation of the policy, but more importantly it increases the strain on the GPs. Many GPs already have full schedules (some practices have closed their books to new patients), and it is not clear if there is sufficient capacity to meet any increased demand. The entire medical industry is facing a sustainability problem - I hear from friends that there aren't enough doctors to train enough new doctors to keep the system going. This is a bigger problem that needs urgent resolution first. The Association of Salaried Medical Specialists, the Public Health Association, and the Nurses Organisation have all said that the free GP visits up to 13 policy is a step in the right direction, but ignores the wider funding shortfall of $224 million in the health system.

There is plenty of suspicion about these policies as an election year "bribe", essentially tempting the electorate to vote for parties that offer "free" things that people would otherwise have to pay for. While the policy to increase the free GP visit age to 13 seems to be a good policy for helping our children, free GP visits for those over 65 seems to be a more obvious attempt at attracting votes from the older segment of the population. There have been some serious questions about whether that part of the policy is financially tenable, particularly when it is expected to be funded from increased tax rates. Additionally, it is harder to sell the policy on purely moral grounds when the population over 65 typically should be responsible for their own finances and should be able to take their healthcare into account. Only 6% of those over-65 say that they have avoided a GP visit due to the cost; this policy targets a relatively small problem and funding the other 94% is probably an ineffective use of limited government funds. It is difficult to justify this policy when the government already spends 13.2% of all government expenditure ($10.9 billion) on superannuation. In fact, the Labour Party has said that they will likely have to raise the superannuation age to 67 (due to the unsustainable cost of superannuation), and raise the age of entitlement for free GP vists to 67 at the same time.

Verdict: If free GP visits are a good thing, then why can't we extend it to the entire population? At the end of the day the government does not have infinite money and it is a question of how much the government can afford. It becomes a matter of ideology - should the government support more people, or should people support themselves? Personally, I would rather see GP visits covered for all children (but not over 65s) in New Zealand than tax cuts, but ultimately this has to be balanced with affordability, and spending large amounts of money to cover all individuals seems excessive when the problem only seems to affect certain groups of people. Perhaps a more targeted scheme is necessary to ensure that our money is being spent efficiently where it is needed.

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