CSC holders information December 2018

During the 2017 election campaign, both major parties announced a reduction in the patient co-payment for CSC holders, plucking out of thin air seemingly, a fee to patients of approximately $18.

When the govt payment to doctors on behalf of the patient (GMS fee) was introduced in the late 1930s, it constituted a significant portion of the costs at the time, but never kept up with inflation - it started as 7/6d & when I started Templeton Medical in 1979 it had reached the lofty sum of $1.25.

We now have a bulk capitation payment, whereby the govt pays us a monthly sum based on the number of registered & enrolled patients - this varies according to sex & age-band, but never took account of CSC status to any great degree, so that all adults paid the same.

When introduced, the formula made assumptions about the frequency of consultation rates & we were informed that Ministry of Health would monitor usage so that the formula could reflect utilisation rates. This has never happened.

Part of the NZ First policy was to extend the "free under-13s" programme to under-14s; in their wisdom, Ministry made an adjustment of the capitated rate of consultation in this group from 2/year to 2.2 consultations per year. Most parents would think themselves lucky if their children were seen that infrequently, so you will appreciate that when we see an individual more times than their "rate", it is the practice subsidising the fee. We were not given an option as to whether to accept the "free under-14s" - we were told that if we did not, the funding for the under-13s would be withdrawn. We were also only given a 3 week timeframe to decide on whether or not to accept the increase.

Keep in mind please, that this funding is a patient entitlement, yet Ministry & govt have structured it as a practice payment.

The Ministry has set a new bulk payment rate for adult CSC holders & their dependant children (aged 14-18 yrs) to commence on 1st December 2018. This is based on between 3 & 6 individual consultations per year - it varies with different age-bands; it assumes a practice fee to adults of $46, already $6 less than our current fee. It does not take into account the high probability of more frequent attendances ("you value what you pay for") & this is something that almost all practices in NZ fear - the fact that we are often already stretched to see patients within a mutually preferred timeframe, so that discontent at accessing your preferred GP (or not) may rise with increased access demand by CSC-holders.

At this stage it seems ACC is adjusting their rates to reflect the CSC policy & these will apply to all practices as their fees are gazetted, so the ACC part-charge will drop - still to be announced & confirmed.

 We are very committed to looking after all our patients & when you consider the full service offered to you by Templeton Medical, with no hidden costs, we trust that you will understand our position in not taking up the new funding at this time. Of interest is that in the past 12 months, the average fee charged to CSC-holders per consultation has been not a lot higher than the regulated fee.  This shows our awareness & commitment to care at an affordable price.  But we cannot at this stage enter a business model with no definite figures, (only theory),  no way of knowing the impact from increased demand and certainly not to be held ransom by a govt department.

This is not a punitive measure, but practice viability may be at stake. The most concerning feature of the funding is the nasty barb that the patient co-payment is capped by Ministry - ie the very independence of general practice is at risk. The medical centre with its facilities; the high staff ratios meaning a high quality delivery of care in a traditional family practice model; all of this is at risk with control by a Health Ministry which has already failed to honour promises made to general practice. 

Should you feel you need to change practice to one with the $18 fee, we wish you well but would ask you to consider all costs in doing so before; we generally are unable to restore your enrolment with us at a later stage should you change your mind

 Pete Wilkinson                ( on behalf of your practice team ).