By Ben Leonard.

About one in five disabled adults cannot afford to visit a GP – hindered by consultation and transport costs. Ben Leonard reports on the changes our system needs. 

The Government’s planned changes to disability support must address the cost of accessing primary healthcare, the Disability Rights Commissioner says.

Along with the announcement of a national health service last week, the Government also said changes to the way disability support is managed would be revealed in September.

Disability Rights Commissioner Paula Tesoriero says the review needs to address the fact many disabled New Zealanders cannot afford to visit a general practitioner (GP).

Last year's New Zealand Health Survey found 21.5 percent of disabled adults were not visiting a GP due to cost, compared to 12.7 percent of non-disabled adults. After adjusting for age and gender variations, that means disabled adults are 2.3 times more likely to not be able to afford to visit a doctor.

Tesoriero says GPs play a pivotal role as the first port of call for disabled people accessing the health system.

Missing a visit can mean failing to catch health problems early when they are easier and cheaper to treat.

Meanwhile, disability advocate group CCS Disability Action says the impact of not going to the GP can be “catastrophic” for disabled people.

CCS policy analyst Phoebe Grace Eden-Mann says many disabled people need access to specialist care that require a referral from a GP.

“Take bowel cancer for example, if a disabled person is experiencing symptoms of this then they need to go to the doctor, but if they can’t afford to do so, then by the time it is discovered then it can be way too late,” she says.

There is also the issue of medication costs. While the majority of medication is subsidised, the costs for people on multiple prescriptions can still be too high for some.

“If you get prescribed four medications, that’s $20 on top of the appointment costs,” says Eden-Mann. “For some disabled people that is well above what they can afford.”

Disabled New Zealanders are over-represented in most measures of financial hardship, being twice as likely to be unemployed as others. They are also more likely to work part-time, and those who do work full-time typically earn less than their colleagues.

Currently, disability support services are planned and funded through Disability Support Services (DSS) and their 16 Needs Assessment and Service Co-ordination (NASC) offices around the country.

The NASCs allocate Ministry-funded support services and work with disabled people to identify what supports they can receive. The service caters for around 40,000 disabled people annually.

Advocates have been calling for changes to the DSS for years, arguing that funding needs to be increased and targeted more effectively. One major issue is the purse strings are still controlled by the Ministry of Health.

The 2020 Health and Disability System Review recommended situating the money with District Health Boards, but the recent announcement of their removal leaves the door open for a new model. The recommendation to devolve control to the DHBs was not popular with some advocates, including the New Zealand Disability Support Network and Disabled Persons Assembly.

“Personally, I’m agnostic on where the funding should sit,” says Tesoriero. “What’s more important is the level of funding and the choice and control of disabled people.”

Tesoriero would also like to see the Government consider increasing the disability allowance. The allowance currently pays up to a maximum of $66.11 a week, depending on what costs a person has. The child disability allowance has been singled out as particularly low - a third of what the United Kingdom pays. 

One of the major costs preventing disabled people from visiting their GP was transport. This includes public transport costs as well as more expensive options like mobility taxis. The health survey found disabled adults were 6.5 times more likely than non-disabled adults to be unable to access GP services due to a lack of transport.

Another major cost barrier is the upfront payment at the doctor's office, sometimes called co-payment or consultation fees. These fees can vary depending on the practice, but basic consultation for an adult patient would generally be between $50 and $75, according to the Royal New Zealand College of General Practitioners.

Even with options like community services and instalment payments, for some the cost is still too high. Some practices refuse to see people if they have outstanding bills.

Tesoriero says she was pleased to see the Government publicly recognise that disabled people have not been well-served by the current system. However, she wants to see them have more input after a lack of consultation in last year’s review undermined confidence in the report and its recommendations.