The cost of accessing GP services has been described as a ‘catastrophic failure’, meaning emergency departments are overwhelmed and many go without seeing anyone at all. Collin Tukuitonga and Grace Shaw make the case for free primary health care. 

Funding for our health system is a little back to front. There are significant financial barriers at the front end of the care spectrum when people first access the formal health care system at the primary care level. Meanwhile, costly hospital-based specialist services are free, including Emergency Department services. 

Primary care refers to general practitioner (GP) and nursing services based in the community and the financial barriers (i.e. the fees charged per visit) affect low income families including Māori and Pacific people. The cost of GP visits has a particular impact on disabled New Zealanders with disability advocate group CCS Disability Action describing the cost of accessing GP services as a ‘catastrophic’ failure.

So it comes as no great surprise to learn hospital emergency departments, with their fee-free services, are overwhelmed with patients – especially during the winter months.

The problem is compounded by the complexity and funding for after-hours care in Aotearoa New Zealand. In many cases, it is often difficult to find appropriate GP medical care for health problems at a time when most services are not available. So again, patients end up in hospital emergency departments.

The community services card and the very low cost access scheme each aim to eliminate the barrier of cost in primary healthcare, but they are inadequate and there has been no change in the rates of New Zealanders unable to access GPs due to cost. For adults who qualify for a community services card, a GP visit at a cost of $19.50 remains unaffordable for many already struggling to make ends meet.

And so the cost of primary care, the cost of prescriptions and the shortage of GPs leads to overcrowded emergency departments in order for many New Zealanders to access affordable care.

Furthermore, even though we have excellent nursing services in the community, these are not fully utilised. There is good evidence to show nursing interventions at the primary care result in good health outcomes, similar to the levels achieved by GPs.

Reform of the Health and Disability system announced in April 2021 did not include any change to funding arrangements for primary health care so it remains a complex mix of public funds and user contributions, made either directly or through insurance arrangements.

This would be a good time to review and reflect on these funding arrangements and look at how we can best improve access and reduce health inequities in Aotearoa New Zealand. It would be an opportunity to increase investment in public health and disease prevention alongside interventions to reduce the impact of the social, economic and commercial determinants of health.  The Health Care Aotearoa Coalition recently produced an excellent case for increasing investment in prevention.

Furthermore, we should also consider fully funding primary health care services to enable early and full access to health care and remove financial barriers. Funding support for primary care nurses should also be further developed. Additional investment in the development of community-owned Māori and Pacific primary care providers would also improve access to and quality of primary health care.

Concerns about abuse of a free primary care services are unfounded and many countries with similar political, social and economic characteristics similar to us provide free primary medical care to their citizens.

There may be some opposition from the primary care community who regard general practice as private enterprise but is worth reflecting on what is best for the patient.

Dr Collin Tukuitonga is Associate Dean Pacific and Associate Professor of Public Health at the University of Auckland and a member of the Health Quality & Safety Commission Board

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