One of National’s big promises this past election was free doctor’s visits for all children under 13. This is a pretty big deal for people in poverty, whose children often stop going to the doctor for anything less than an emergency department visit after they turn six. Free visits for under-13s has the potential to reduce diseases of poverty such as rheumatic fever, with early intervention preventing serious consequences.
Today it was revealed that this promise is being broken. Yes, there will be ACC funding for injured children. No, it won’t be enough to cover everyone. Perhaps 90% of injured children will be covered by the $24 per injured child of funding, but that still leaves 10% having to pay a co-payment for their care. Incredibly, Health Minister Jonathon Coleman suggests that if your child is injured and your doctor’s receptionist states that they ask for co-payment, you should take your injured child on down the road a couple of hundred yards to the next doctor’s practice. I shit you not, that’s what he said.
There are a few issues with this. First is the rural issue. If you’re in a smaller town, you don’t have the option of waltzing down the road to the next place. There is no next place. You take what you get, and you deal with it. From that perspective, this is an incredibly privileged townie idea. It denies the reality of rural and small-town life. Many poor people live rurally or in small towns, making money when shearing time or the grape harvest comes around, and living on very little in the meantime. These people often live an hour or more from the nearest emergency department, so primary care is very important in this setting.
Then there’s the issue of having a regular GP, one that has known your child since they first came in for immunizations at six weeks old. Not only do they know your child and hold al their medical records, but you are also enrolled as part of their PHO, and if you go to another practice that’s not an urgent care clinic, you risk having your whole family deregistered. Which brings me around to the next problem . . .
Trying to find another GP to take you on is next to impossible. In small towns there’s no-one else. In cities the waiting lists are horrendous, to the point where some people don’t have GPs and have to cobble together care from urgent care clinics, youth one-stop shops, outreach clinics, and emergency services. Even if you’re just looking for a one-off appointment with a doctor, rather than enrolling with them, it’s likely to be hard. Doctors are crazy-busy, and they’re likely to be filled up with their own patients.
Finally, there’s the ridiculousness of having an injured child and being told at the clinic that they don’t do free visits, and taking your child, who is in pain, and cruising off to the next place to try again. Who’s going to do that? Well, people who really don’t have any money available will have to. Yeah, you should probably know before the crisis what your GP charges, but for people that don’t go very often that’s not necessarily assumed knowledge.
Funding 90% of ACC visits isn’t that terribly bad, in that most children will be subsidised, and it is likely that most urban poor will be covered. I don’t know what it’s going to be like for those outside the main cities, though. I remember rural GP care being quite expensive when I lived rural, and I wouldn’t be terribly surprised if it’s clinics in the middle of nowhere, as well as expensive town clinics, that impose a co-payment.
Something that hasn’t been raised that interests me is that this is talking about ACC funding. What about non-ACC stuff? Is that going to be funded? Where will that funding come from, and who will it cover? I would love to know. And prescriptions were supposed to be free. Is this happening?
This is a broken promise, and one that has the potential to keep kids that desperately need primary care intervention locked out. New Zealand kids deserve better.