How much do urgent care fees vary within 21km in Auckland?
Urgent care is accessible but the fees, and the wait times, are quite varied around the Auckland.
Photo:
RNZ
It's lunchtime on a Tuesday at the White Cross
urgent care
clinic in the south Auckland suburb of Otāhuhu.
"Today is our fourth time in four weeks and today we've had to pay $150. So the twins are free, but me and my partner is $65 each."
A mother told me the family had to come back to the clinic for another prescription, because sickness was spreading at home.
"The virus that my daughters have caught doesn't go away unless you get antibiotics. And now we've caught it so we need antibiotics too, which their antibiotics won't work for us. It's just getting worse and worse. And if they get better and we've got it, we just end up giving it (the virus) back to them."
The Otāhuhu clinic is close to home for the family, and it's cheaper than other urgent care clinics.
"This is the most affordable one to take us in this fast. Our Local Doctors (a GP clinic) can't take us in for another three weeks. The last time we've been to the doctors for ourselves was probably two years ago. We just tough it out because it's too much amongst all the other bills that we have to pay.
"Today we're gonna have to cut short on food. We haven't done our grocery shopping for the week yet, so it's gonna be what the twins need, and then whatever's left."
By "take us in this fast", the mother meant: "eight hours with two two-year-olds, gonna be great."
As part of the Budget this year, Health Minister Simeon Brown promised greater accessibility to urgent and after-hours healthcare in the regions, with several new 24-hour services planned around New Zealand.
Health Minister Simeon Brown.
Photo:
RNZ/Marika Khabazi
Meanwhile in Auckland, urgent care is accessible but the fees, and the wait times, are quite varied around the city.
Three hours later, I crossed path with the family again - 7km away at the White Cross clinic in Mount Wellington.
At White Cross Otāhuhu, the cost for an un-enrolled adult without a community services card is $70. Meanwhile in Mount Wellington, the fee is $130.
The mother said they were sent by staff at Otāhuhu to Mount Wellington at no extra cost, so their wait could be shortened by half.
They told me the Mount Wellington waiting room is much quieter than Otāhuhu.
Further south, the cheapest White Cross clinic is in Manurewa, where an un-enrolled adult without a discount pays $60, and $15 if ACC offers cover. Enrolled adults pay $18, and if they've got ACC coverage, it's free.
It's an attractive price for many patients.
A woman told me this is the cheapest clinic that she knows of, and she drove 10km that day to see the doctor.
"Just for a follow up, it's $18."
Another man told me the price is vastly different between two clinics 9km apart.
"In Takanini, I think the charge for a repeat prescription is around $15 to $20, but here it's around $7 to $10."
Meanwhile in Remuera, one of Auckland's affluent suburbs, the White Cross Ascot 24/7 charges $130 - more than double the $60 charged in Manurewa.
A couple who just finished their consultation told me they are enrolled with the Tāmaki Health network, so it cost them $80 in Remuera.
They say their bill could be cheaper if they travelled to a clinic further away, but in this case, they think their health is more important than the money they could save.
"It was $80 because I was in pain, and this was the nearest hospital from my work," the woman said.
"Where we go most of the time, it's about $17 or $18, then if it's after 5pm, that's $35. But she was working here, so it was convenient for her to come here," her partner added.
Their wait that day was two hours.
Malcolm Mulholland from Patient Voice Aotearoa said cost was the number one factor in determining whether patients access healthcare.
"I know that there are a number of families and patients out there who won't go and see their GP, primarily because of cost. And when that situation does arise, what tends to happen is as the patient's health deteriorates, they end up going to the ED and that's why we are seeing ED with record number of patients."
Mulholland said many factors play into how practices price their fees: location, competition, demand and funding level are just a few.
He lives in Palmerston North, where there is only one after-hours clinic. It costs $210 to see a doctor during normal hours, and $240 on weeknights.
The Palmerston North clinic also belongs to Tāmaki Health, which manages the White Cross network of urgent medical clinics.
Tāmaki Health declined to comment, or provide a statement for this story.
I asked Mulholland if there's anything patients can do to cut their bill.
"Sadly not. I don't know if there is much that patients can do other than try to be seen during the day. But again, you're gonna run into problems with GP practices being full and then the wait time to see a GP.
"I think that's a really sad state of affairs because you're essentially asking patients to triage themselves and patients won't always make the right decision."
And Mulholland said it all came back to the desperate need for more doctors.
"Patients are worried about their health. They can't get access to a GP or a doctor, whether that be during the normal working hours or via an ED. And so they're going wherever they think they might be seen."
In May, the government announced a $164 million investment in urgent care. As part of the improvement, the agency noted it would implement a nationally consistent fee and subsidies schedule.
In a statement to First Up, director of Living Well at Health New Zealand Martin Hefford said, "Health New Zealand is shifting from a fragmented system with wide fee variation to one that's more transparent and predictable across the country."
There would still be some variation of fees, Hefford said, but the details were not finalised yet.
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The motel manager told RNZ that she and V became very close in the three months they lived there - but she was not aware the teen's health was deteriorating. "V was very anorexic when they came and continued to be so." But because the teen always wore a puffer jacket and baggy clothes, it was hard to tell whether things were better or worse, she said. "My concern was for that sad child. "My main concerns were 'Can I help this person become more resilient? Can I help them find happiness? Can I help them get hold of life somehow and enjoy it?'." The teenager repeatedly assured her they were "eating OK", and social workers from Housing First (run by the Salvation Army) regularly visited clients at the motel. "To be honest I knew very little about anorexia, but I now know that people with anorexia are very good at covering what they are doing or not doing." V frequently went food shopping and discussed food, there was "always food in the fridge". "We only discovered afterwards that lot of food was returned to the shops and money refunded." At Christmas, she gave V dinner and "treats". "As far as I know, no-one else visited. We were the only ones who gave V any presents for Christmas or their birthday." She described the teenager as "absolutely delightful". "They couldn't make eye contact but weren't averse to physical contact. "V would frequently ask me if it was alright to have a hug. "The only time they got upset with me was when I suggested that at some point, they had to learn how to do some things for themselves because they would be living independently in the future, and they didn't want that. "That scared them, they wanted to stay here. "V told me this was the safest they had felt for years, here with us." The last conversation she had with V was two days before they died, when she tried to get V to make their own bed. "I refused to do it because I was trying to encourage them to do more things for themselves. "V said to me 'L, do you hate me?'. And I said 'No, I love you, that's why I'm asking you to make your own bed'." She found out later that V had persuaded another guest to make it for them. "That guest is pleased the last thing they did for V was something kind." V's death was a tragedy, she said. "They were a lovely person - we laughed and chatted, it was a pleasure to know them and I'm just really happy that - at least for the time they were here - they enjoyed themselves, they felt safe, they were comfortable." Vanessa's parents both saw her for the last time on 1 January, 2023 - but only at a distance. "She was wearing a puffer jacket in the middle of summer. She wouldn't let us near to see how thin she was, using the excuse 'You don't accept I'm a man'." However, her parents said subsequently, Vanessa phoned her father and then her mother to say she was "seriously questioning the 'gender identity thing'" and wanted them to know she was indeed their daughter. They were hopeful their child could be returning to them, but that was not to be. In an email to V's GP, the Family Works team leader said the teenager had dropped "a significant amount of weight" since she had last seen him in early December. "His weight loss alerted several staff members in the office. I spoke with V about his health and encouraged him to make an appointment with his GP to ensure he is getting the appropriate support." The teenager reported feeling tired from exercising and "overwhelmed" due to autism. "He fell to the ground at one point saying his legs were so tired, when I dropped him at home, he lifted his legs to get out of the car. He stated he has enough food and is eating well, as well as sleeping okay, however this is not obvious in his physical appearance." The worker said she was "breaching his confidence" because she was so concerned for him and wanted to alert the doctor. A GP appointment was booked for the next week - by then, however, the teenager would already be dead. "I do not understand why no-one called an ambulance that day," Catherine said. "How can it be that a child collapses in front of all these people [at the Family Works premises] and no-one calls an ambulance?" It was the height of summer and temperatures were sweltering. Catherine later heard the teenager had asked the motel manager for a walking stick and a hose to drink water from the tap without getting out of bed. "The manager said she thought it was weird but did nothing about it. I asked her as calmly as I could 'A minor asks you for a walking stick and a hose to drink water from the tap - are you not going to anything about it?'. "She got angry with me and said 'We are a motel, not social services'." The motel manager told RNZ she did not recall any mention of a walking stick, but the comment about the hose pipe had been taken "out of context". "V often made odd requests. With hindsight it possibly meant more than it sounded like, but it wasn't uncommon for certain requests that were unusual." Catherine said Vanessa last left her motel room on a Thursday. Saturday was her parents' wedding anniversary, and they decided to go for a drive in the country and were out of cellphone reception for a few hours. After that final text on Saturday night, Vanessa could not be contacted. "She would always text back because she knew I got worried. So we were worried." On Monday, Catherine rang the motel, but the manager said if it was not a "professional call", she could not put it through. So Catherine rang Vanessa's GP, who organised "a welfare check". When Catherine rang the motel again, the phone was handed straight to a police officer. "I knew immediately that Vanessa had died." When they arrived at the motel, there was a stench. Vanessa was lying in bed with her laptop propped up on her lap, dead two days. "At the scene, the Police corrected us when we used Vanessa's name and insisted on using a male name and pronouns," remembers Catherine. "I was so distressed by this." Vanessa's parents believe the teenager's death was the result of the removal of the protections of the Compulsory Treatment Order nine months previously. Catherine said it appeared there was "wilful blindness" on the part of those professionals, who were so focused on affirming Vanessa's gender identity, but did not pay the same attention to the eating disorder which would kill her. Their crushing grief is made worse by the knowledge that so many chances were missed. "Acknowledging and reporting her deterioration would have been a simple matter. Had they done so, our treasured daughter would still be alive." *Names have been changed for privacy reasons. Health New Zealand National director mental health and addictions service enhancement Phil Grady: "On behalf of Health New Zealand, I would like to extend our sincere condolences to this family for their loss, which we recognise has had, and continues to have, a profound and long-lasting impact. "As the matter is still before the Coroner, it is not appropriate for us to comment further at this time." Oranga Tamariki Deputy chief executive tamariki and whānau services Rachel Leota: "The death of any child is devastating for their family and community, and I would like to acknowledge the grief this young person's family will feel. "As this matter is still active before the coroner, we are unable to comment further at this time." Ministry of Social Development Group general manager client service delivery Jayne Russell: "Because your questions involve matters before the Coroner, we are unable to comment." Ministry of Education Spokesperson: "First and foremost, I want to express my deepest sympathies to you, Catherine, and your family for your loss. I cannot begin to imagine the pain of losing Vanessa. "Because this is an active case before the Coroner, we are unable to comment. I understand how difficult it must be for you and please know that our thoughts are with you, and we appreciate your understanding." Presbyterian Support Tumu Whakarae Tauiwi (Co-CEO) Barry Helem: "I am not able to provide any comments regarding an individual client. Presbyterian Support contractually cannot provide personal information as all client case notes are held by the Ministry of Social Development Youth Service Support Unit. "It would also not be appropriate to comment while this tragedy is under active review by the Coroners Court. "Our service is contracted to the Ministry of Social Development to assist young people to access the Youth Payment benefit. Part of a young person's obligations in receiving the benefit is to engage in education where clients have a choice of which area of study they wish to pursue. Our Youth Coach roles are not social worker positions; however, staff often advocate for clients and refer to other agencies/organisations if clients require other supports such as; a client's GP, transitional housing providers etc." The Salvation Army Regional housing manager: "In regard to your query relating to Vanessa, The Salvation Army has supported countless New Zealanders over the years in their housing situations, and we always complete regular assessments as well as care and support procedures for tenants, often in collaboration with referrals from other organisations we work alongside. "We are bound by strict guidelines under privacy legislation and professional social work ethics to protect the dignity and confidentiality of those we support, regardless of whether they are named publicly or not. Even with assurances that a person will not be identified, questions that pertain to individual cases risk breaching those standards. For this reason, we are unable to comment on specific individuals or their circumstances." If it is an emergency and you feel like you or someone else is at risk, call 111. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
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