Zero fees for under-13s

Zero fees for under-13s

Wednesday, July 1, 2015

WHAT

From 1 July, most general practices will offer zero-fee visits for children under 13. To find out more ask your general practice team.
You’ll no longer need to pay the $5 charge for each item of prescription medicine for under-13s, though other charges may apply. To find out more, check with your pharmacist.
Your local DHB will ensure that children under 13 can access zero-fee after-hours care and prescription medicines in your area. After-hours services are designed for urgent visits when the child’s regular practice is closed and where the child needs to be seen before the practice opens again. Ask your general practice or pharmacist where to find these services.

Why

These changes will improve access to healthcare for primary and intermediate school children, ensuring they can get the care they need when they need it and avoid possible complications and visits to hospital A&E departments.
We want to ensure that as many families as possible take up the availability of zero-fee primary care. More than 410,000 6-12-year-olds children are enrolled with general practices.
All Very Low Cost Access (VLCA) practices which cover high need populations will be required to offer zero-fees visits to under-13s - 35 percent of the 6 -12 age group is enrolled in a VLCA practice.

How

The ’zero fees’ scheme applies to a standard daytime visit to a GP or nurse at the child’s regular practice (where they are enrolled) or an after-hours visit to a participating clinic. It also applies to injuries covered by ACC.
During the day if you are not going to your regular practice you may be charged a fee; make an appointment with your regular practice if you can.
Extended general practice consultations, procedures and extra services such as certificates or equipment will continue to be charged in the usual way. Pharmacies may also charge for extra services such as medicines delivery or packaging, in addition to fees for medicines that are not funded by Pharmac.
General practices can decide whether they offer zero-fee visits for children under 13. The vast majority of practices offer zero-fee visits to children under six and we expect the same for under-13s. The Government will provide an additional subsidy to practices who offer zero-fee visits.
Give your general practice a call and ask if they provide zero-fee visits for under-13s or check your practice website.
If your regular practice doesn’t offer zero-fee visits to under-13s, you can choose to enrol with another practice that does.
For more information see www.health.govt.nz/visiting-a-doctor . You can also get advice from a trained nurse by calling Healthline on 0800 611 116 or Plunketline on 0800 933 922.

 

ZERO FEES FOR UNDER-13s FAQs

Who is eligible for ‘zero fees’?

From 1 July 2015 all children aged under 13 are eligible for free visits during the day from a GP or nurse at their usual practice. Ask your general practice if they provide zero-fee care for under-13s or check your practice website.  Any child who isn’t already enrolled with a general practice can enrol for free.

What does the scheme cover?

The zero-fees scheme applies to a standard daytime visit to a GP or nurse at the usual practice where the child is enrolled, or to an after-hours visit to a participating clinic. It also applies to injuries covered by ACC.

During the day if you are not going to your regular practice you may be charged a fee; make an appointment with your regular practice if you can.

Fees for extended consultations, procedures and extra services, such as certificates or equipment, will continue to be charged in the usual way.

Which practices are offering zero-fees visits to under-13s?

General practices can decide whether to offer zero-fee visits for children under 13. The vast majority of practices have opted into the scheme.

Practices in the Very Low Cost Access scheme which cover high need populations automatically provide zero fees to under-13s. If your regular practice doesn’t offer zero-fee visits to under-13s, you can choose to enrol with another practice that does.

Will all practices that already provide free visits to under-6s also provide free visits to 6-12 year olds?

Individual practices can choose whether to opt in to the extended scheme. Practices who have offered zero fees to under-6s have the option of remaining in only the under-6s scheme.

From 1 July 2015, any practices not in the current under-6s scheme who wish to opt into the zero-fees scheme can only opt into the under-13s scheme, covering all children aged up to 13. 

Practices can also choose to opt out of the scheme at any time.

Will the scheme mean practices spend more time and money on under-13s at the expense of other patients?

Government funding for the zero fees scheme has been based on the average number of visits by 6-12 year olds in a range of practices, including those in high needs areas, as well as the experience of introducing zero fees for under-6s.  It allows that the average number of visits in a year may be slightly higher when there are no fees to pay.

When the zero fees for under-6s scheme was introduced practices experienced an initial increase in utilisation rates, which then levelled off.

The Ministry of Health will closely monitor the number of practices offering zero-fees care and the numbers of children who access it. There are mechanisms for reviewing Government subsidies to practices that offer zero fees if there is an unexpected increase in the number of children using general practice services.

Over time, early intervention is designed to improve child health by avoiding complications as well as hospital visits.

What about after-hours care?

DHBs will ensure that children under 13 have access to zero-fee after-hours care and prescription medicines in their local area. DHBs must ensure reasonable travel time (maximum of 1 hour) to after-hours general practice and pharmacy for 95 percent of their enrolled population.

After-hours services are designed for urgent visits when the child’s regular practice is closed and where the child needs to be seen before the practice opens again. Ask your general practice or pharmacist where to find these services.

When do free visits to after-hours services apply?

This will depend on the arrangements that are put in place by the DHB for access to after-hours services within 60 minutes travel time.  If the child’s regular general practice is not open on a Saturday then a visit to the contracted after-hours service will be free. 

What about consultations covered by ACC?

All general practices will receive an extra contribution from ACC to enable them to provide free visits for injured children under 13. GPs can choose to charge a fee, but it is expected that the increased contributions will allow most GPs to provide free visits for under-13s for injuries covered by ACC.

What about prescription charges?

From July 1 2015, the $5 charge for each item of prescription medicine will be removed for children under-13, though pharmacies may charges for extra services such as medicines delivery or packaging. Fees for medicines that are not funded by Pharmac remain the same. Check with your pharmacist about any additional fees.

Which pharmacies will provide free prescriptions after-hours?

DHBs will arrange for at least one pharmacy in their area to provide free prescriptions after-hours within reasonable travel time (maximum of one hour) for 95 percent of the enrolled population. 

What about prescriptions from hospitals?

The $5 charge will be removed from all prescriptions for children under 13, including prescriptions written by hospital specialists, dentists, nurses and other health professionals.