Jacinda Ardern - our new PM

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# 1958954 16-Feb-2018 09:58

Rikkitic:

So is this because Labour wants to reduce fees (not a bad idea in itself) or because the system is broken, which I would imagine goes way back?

It's because Labour has not considered BOTH sides of the equation with their policy (and increasingly common theme, that surely even you must be able to see). They are reducing fees but not increasing funding which means that they have essentially told Doctors to fund these changes.

Do you think that's fair?

Rikkitic

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# 1958992 16-Feb-2018 10:14

It doesn't sound reasonable to me but I don't know enough about it to venture an informed opinion. I imagine if the government did provide funding, certainly people would start complaining about them splashing money around.

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# 1958994 16-Feb-2018 10:21

As heavy user of the health providers this idea of Labour scares me a lot. It won't make easier for folks to get the help they need it will get harder. I would see a worsening of the doctor short fall.

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# 1958996 16-Feb-2018 10:22

Rikkitic:

It doesn't sound reasonable to me but I don't know enough about it to venture an informed opinion. I imagine if the government did provide funding, certainly people would start complaining about them splashing money around.

Both parties were to increase healthcare spending, National after they secured a reasonable financial position and Labour thanks to Nationals prudent financial management. Labour said they would spend a billion more, but cut that number by HALF when they gave Winston his billion to spend in the regions.

I haven't seen any argument from anyone in any thread that suggests healthcare could use a boost in funds.

Labour haven't specifically said they would cut the funding for Doctors as a result of this payment to Winston, it just appears they don't understand the full impact of the policy they announced. Again, a proven trend in Labour Policy.

Labour said it's policies were properly vetted for financial responsibility and meet the "rules" but if you don't "know" that you need to increase funding then you don't know you need to find the money in the first place.

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# 1958999 16-Feb-2018 10:29

MikeB4: As heavy user of the health providers this idea of Labour scares me a lot. It won't make easier for folks to get the help they need it will get harder. I would see a worsening of the doctor short fall.

National have contributed to this as well, so I can't lay the blame squarely at the feet of Labour, but as someone who lives with someone who has spent a lot of time both in hospitals, in the regions and as a GP, I can tell you we are heading for a major GP Crisis in NZ. People will die. This isn't hyperbole and scare tactics, it's absolute fact. The problem is that the press will blame the doctors for failing to provide care.

I know for a fact this has been outlined to the relevant people in both parties. National said they would address it this term and had started to engage with the GP College, but Labour has not responded. Also worth nothing at the same time National were told of how bad it was, Labour was also told (in opposition).

Being a doctor in NZ isn't attractive to potential new doctors, the number of schools seeing people taking subjects that lead them to medicine is down a lot apparently.

A Number of doctors we know, voted Labour because they felt the healthcare package Labour was proposing was better than Nationals plan, those doctors were almost all specialists at hospitals. Those doctors are SEETHING right now at what they consider absoloute betrayal that Labour will not enact more than half those things now.

Whilst it's not possible to know what National would have given Winston and where the money would have come from, on the face of it, Nationals healthcare plans looks significantly better than Labours according to those doctors. Of course it's entirely possible National would have cut $500M from healthcare too, but less likely given how much heat they were under at the election over healthcare.

I do understand it's a balance, if healthcare didn't get cut, then education might have, or something else, you can't keep everyone happy.

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# 1959009 16-Feb-2018 10:56

networkn:

So my wife is a Doctor, and last night in one of the groups she is in, a message was posted of a practice (not hers) of 4 Doctors who have analyzed the impact of Labours intent to reduce doctors fees for most people. The practice calculates conservatively, that they will lose $120,000 in their practice each year, as a result of these changes.

This is a result of the fact that cheaper doctors fees, in reality, means that doctors will see each patient more times and that more people will enroll with a doctor, but Labour is doing nothing to change what each practice gets for a patient. On top of that, as a result of being busier, pressure is being put on practices and as a result, the doctors who work there, to see more patients in a day. Most doctors work on a 10-15 minute appointment time. My wife, an experienced doctor, feels that at 15 minutes she doesn't have a full chance to properly provide care, and it's likely practices will mandate 5 minutes less per patient (30%) further reducing the level of care. Female doctors especially will have a more difficult time of this, because traditionally, female medical issues can take more time and be more complex. Also if someone sees an A&E instead of their registered GP, the practice must pay the doctor that saw their patient, and it only takes 3 external visits for the primary care physician to be losing money on a patient, but still require to look after them the rest of the time.

On one hand most doctors believe that more regular visits is better for patient care and health, and more people enrolled is also good, but without doing something to compensate practices for this, it just means doctors already stretched, working long hours will get less money and provide less quality care. It's getting harder and harder to get Doctors into General Practice and the medical council has been asking the Government to urgently address these proposed changes for fear of triggering a national healthcare crisis. Locums are used extensively, but there is a shortage there as well.

I presume you mean that female patients will have a more difficult time? Since females can and do see male doctors about female medical issues? My mother's gynaecologist was a very nice man called Tony Butcher, for example!

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# 1959012 16-Feb-2018 10:59

Geektastic:

I presume you mean that female patients will have a more difficult time? Since females can and do see male doctors about female medical issues? My mother's gynaecologist was a very nice man called Tony Butcher, for example!

Stats show that females prefer to see female doctors. My wifes patient list, for example, is overwhelmingly female and kids. I can't get into specifics obviously, but female appointment times are generally longer.

There are of course some females who see male doctors. Specialists are slightly different as well, whilst I don't have the stats to support this, there are more male specialists.

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# 1959027 16-Feb-2018 11:07

networkn:

Geektastic:

I presume you mean that female patients will have a more difficult time? Since females can and do see male doctors about female medical issues? My mother's gynaecologist was a very nice man called Tony Butcher, for example!

Stats show that females prefer to see female doctors. My wifes patient list, for example, is overwhelmingly female and kids. I can't get into specifics obviously, but female appointment times are generally longer.

There are of course some females who see male doctors. Specialists are slightly different as well, whilst I don't have the stats to support this, there are more male specialists.

Still, it's the patients who will lose out more than the doctors I would suggest.

Just imagine what doctors must feel like in the UK where there is no fee for seeing them, so Uncle Tom Cobbelley and All will make appointments for the slightest sniffle or graze!

MaxLV

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# 1959272 16-Feb-2018 17:44

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networkn:

It's because Labour has not considered BOTH sides of the equation with their policy (and increasingly common theme, that surely even you must be able to see). They are reducing fees but not increasing funding which means that they have essentially told Doctors to fund these changes.

Do you think that's fair?

You're wrong about the funding to GP's not being increased. (more FUD?)

“GP practices will also get a further $46m over and above the funding to reduce fees, a 5 per cent increase on current funding. This will reflect the cost pressures they face and allow for extra demand. With the growing need for more GPs, Labour will also invest $30m over three years to boost the number of GP training places to 300 a year.

“This initiative will cut fees for New Zealanders while we undertake a full review of the primary care system aimed at better targeting subsidies, ensuring practices’ financial sustainability, and reducing other barriers to access. This review will keep zero fees for under 13s and look to further lower fees for others.

“Funding for this policy comes from the $8b of increased investment in health that Labour has pledged to make over the next four years.

http://www.scoop.co.nz/stories/PA1708/S00480/labour-to-cut-gp-fees-by-10.htm

The Labour Party committed to make big changes to primary care from 1 July:

• lower the Very Low Cost Access fee cap to $8 per visit for adults and $2 for teens, with a funding increase to VLCA practices to cover this

• extend the VLCA fee cap to 600,000 more New Zealanders who hold Community Services Cards but aren’t enrolled at VLCA practices (including 350,000 people who will become eligible for the card)

• increase the subsidy by $12 for all practices that lower their fees by $10

• apply the subsidy to both GP and nurse consultations

• increase funded GP training places to 300 per year.

The above, at an estimated total cost of $259 million a year, will be brought in as a bridging measure while a review of the primary care system is carried out, Labour said.

The review will aim to better match subsidies to patient incomes than the VLCA scheme currently does, ensure the financial sustainability of practices and address other barriers to access. The review will keep the fee for under-13s at zero and look to further reduce average fees for others.

https://www.nzdoctor.co.nz/article/print-archive/prospect-middle-class-flight-real-when-vlca-fees-drop-8-moodie

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# 1959397 16-Feb-2018 23:24

I am looking forward to the $16/visit GP visits. I currently pay $69/visit. Tried recently to switch to a cheaper practice and they were full. Currently I dont feel sorry for GP's at all. In the practice I go to they dont do house calls and dont seem to work outside regular hours.

rjt123

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# 1959558 17-Feb-2018 12:02

Looks like JA made the right choice in getting a job and letting Clarke do the cleaning. Lol

http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11996524

networkn

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# 1959708 17-Feb-2018 20:16

MaxLV:

You're wrong about the funding to GP's not being increased. (more FUD?)

“GP practices will also get a further $46m over and above the funding to reduce fees, a 5 per cent increase on current funding. This will reflect the cost pressures they face and allow for extra demand. With the growing need for more GPs, Labour will also invest $30m over three years to boost the number of GP training places to 300 a year.

No not FUD.

You are right, they are increasing it, the numbers I posted are POST the increases that Labour will make. My apologies for suggesting Labour weren't increasing. I wasn't aware those numbers were post increase at the time of my post. I don't think that changes much that I posted however, because it's still a stupidly low amount compared to the extra demand they will put on medical practices and therefore the doctors who work there.

5% isn't an increase that is meaningful, there hasn't been an increase in capitation in some time, not even in line with CPI (Which National didn't do as well) , so the 5% doesn't address prior increases let alone the demand anticipated.

Also worth noting is that Labour has said they will increase the number of positions they will fund for new doctors, however, there is less demand among the highest achieving students to head to medical-related careers. There is a noticeable drop out of students with a B average, over those with an A average in the first 3 years of medical school as it will come as no surprise to anyone that medical school is extremely tough and demanding. If they drop the standards of achievement for either entry or passing each year, you end up with lesser achieving doctors than those who passed with the original standards.

networkn

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# 1959721 17-Feb-2018 20:58

Pumpedd:

I am looking forward to the $16/visit GP visits. I currently pay $69/visit. Tried recently to switch to a cheaper practice and they were full. Currently I dont feel sorry for GP's at all. In the practice I go to they dont do house calls and dont seem to work outside regular hours.

Well, unfortunately, you are in for a shock, if your practice is a high access practice, your visits will probably drop by $10 a year, to $59 not $16. You would need to move to a low access practice. Be aware however, that most low access practices charge for every little thing. Want a plaster $5, want an ECG $50 etc. Not all areas have low access practices (Remuera for example).

Very few practices do house visits. A few do rest home visits regularly and take care of the patients in groups. There are some very good reasons for that. Firstly, when was the last time you had a tradesperson at your house? What did it cost? Imagine the cost of a doctor to your home. Not only could people not afford it, but they wouldn't pay. Also travel time, time away from the practice, the lack of equipment etc. Carrying around medicines.. It's also a massive safety issue, the doctor can't easily reference your history, look up hospital results, male doctor visits young female patient home alone.. Young female doctor visits high-risk area of city to visit patient on her own... Risk. Obviously worst case scenarios, but ones that don't occur to most people.

If you are sick enough to need a home visit, the logic would be you are likely to need a hospital or hospice.

Some rural doctors we know still do it very occasionally. My great Aunt has a doctor who has looked after her for 30+ years, he will make an exception for her, but she pays the privilege, believe me. She can afford it, and would prefer that to a visit to the GP at his practice. She has had the risks outlined to her very carefully. She is prepared to accept that.

I don't expect much sympathy for Doctors, most people have a devil may care attitude about doctors, perceiving them to be so rich that they shouldn't be bothered by rising costs. I can assure you personally, that your average GP probably isn't earning what you imagine, and they work hard for their money.

Pumpedd

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# 1959739 17-Feb-2018 21:55

networkn:

Pumpedd:

I am looking forward to the $16/visit GP visits. I currently pay $69/visit. Tried recently to switch to a cheaper practice and they were full. Currently I dont feel sorry for GP's at all. In the practice I go to they dont do house calls and dont seem to work outside regular hours.

Well, unfortunately, you are in for a shock, if your practice is a high access practice, your visits will probably drop by $10 a year, to $59 not $16. You would need to move to a low access practice. Be aware however, that most low access practices charge for every little thing. Want a plaster $5, want an ECG $50 etc. Not all areas have low access practices (Remuera for example).

Very few practices do house visits. A few do rest home visits regularly and take care of the patients in groups. There are some very good reasons for that. Firstly, when was the last time you had a tradesperson at your house? What did it cost? Imagine the cost of a doctor to your home. Not only could people not afford it, but they wouldn't pay. Also travel time, time away from the practice, the lack of equipment etc. Carrying around medicines.. It's also a massive safety issue, the doctor can't easily reference your history, look up hospital results, male doctor visits young female patient home alone.. Young female doctor visits high-risk area of city to visit patient on her own... Risk. Obviously worst case scenarios, but ones that don't occur to most people.

If you are sick enough to need a home visit, the logic would be you are likely to need a hospital or hospice.

Some rural doctors we know still do it very occasionally. My great Aunt has a doctor who has looked after her for 30+ years, he will make an exception for her, but she pays the privilege, believe me. She can afford it, and would prefer that to a visit to the GP at his practice. She has had the risks outlined to her very carefully. She is prepared to accept that.

I don't expect much sympathy for Doctors, most people have a devil may care attitude about doctors, perceiving them to be so rich that they shouldn't be bothered by rising costs. I can assure you personally, that your average GP probably isn't earning what you imagine, and they work hard for their money.

Their election campaign was very clear....$16 doctor visits for all. National promised $19 visits. There was no buts or exceptions in Labours campaign.

Geektastic

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# 1959752 17-Feb-2018 23:14

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networkn:

Pumpedd:

I am looking forward to the $16/visit GP visits. I currently pay $69/visit. Tried recently to switch to a cheaper practice and they were full. Currently I dont feel sorry for GP's at all. In the practice I go to they dont do house calls and dont seem to work outside regular hours.

Well, unfortunately, you are in for a shock, if your practice is a high access practice, your visits will probably drop by $10 a year, to $59 not $16. You would need to move to a low access practice. Be aware however, that most low access practices charge for every little thing. Want a plaster $5, want an ECG $50 etc. Not all areas have low access practices (Remuera for example).

Very few practices do house visits. A few do rest home visits regularly and take care of the patients in groups. There are some very good reasons for that. Firstly, when was the last time you had a tradesperson at your house? What did it cost? Imagine the cost of a doctor to your home. Not only could people not afford it, but they wouldn't pay. Also travel time, time away from the practice, the lack of equipment etc. Carrying around medicines.. It's also a massive safety issue, the doctor can't easily reference your history, look up hospital results, male doctor visits young female patient home alone.. Young female doctor visits high-risk area of city to visit patient on her own... Risk. Obviously worst case scenarios, but ones that don't occur to most people.

If you are sick enough to need a home visit, the logic would be you are likely to need a hospital or hospice.

Some rural doctors we know still do it very occasionally. My great Aunt has a doctor who has looked after her for 30+ years, he will make an exception for her, but she pays the privilege, believe me. She can afford it, and would prefer that to a visit to the GP at his practice. She has had the risks outlined to her very carefully. She is prepared to accept that.

I don't expect much sympathy for Doctors, most people have a devil may care attitude about doctors, perceiving them to be so rich that they shouldn't be bothered by rising costs. I can assure you personally, that your average GP probably isn't earning what you imagine, and they work hard for their money.

We get charged around $50 but certainly get some other charges. The one that REALLY annoys me is the repeat prescription charge.

Like a few others here, I have to take meds for the rest of my life. They won't ever stop unless there is an enormous leap in medical ability. I'm talking Star Trek style "jump in the scanner and all fixed, off you go my lad" kind of jump.

Yet, every 3 months, I get billed another $15 just so that they can print out the same prescription they have printed out every 3 months for years and sign it.

On a side note, our practice prints an A5 sheet of paper and hands it to every patient seeing the doc or nurse. The doc or nurse then marks on what they did for billing and you give it back to the receptionist who looks at it and raises the invoice. The geek in me screams at such a ludicrous waste of paper. There's a computer in the doctor's office and the nurse's offices, and two more on the reception desk. Surely they can make a way for them to communicate the billing without wasting ream after ream of A5 paper every year?!

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