Latest news with #GreenCross
Scoop
18-05-2025
- Health
- Scoop
Have You Heard Of Capitation? This One Weird Word Is Why You Can't Get A GP Appointment
Well, it's one of the main reasons. On Friday, NBR's Tim Hunter wrote an article, A window on the world of general practice (paywalled), outlining some realities of the GP industry. And it is an industry – almost all family health clinics in Aotearoa New Zealand are not part of the public healthcare system. They are privately owned, or run by a corporate group. 'Anecdotally, GPs are underpaid, overworked, stressed out and thinking of moving to Australia,' Hunter writes. He also quotes the Government's 2022 Sapere report saying practices probably earn less than the cost of delivering care. 'We know this is true,' says General Practitioners Aotearoa (GPA) chair Dr Buzz Burrell. 'Clinics struggle to recruit GPs, or pay them well enough to keep them.' Many GPA members who work at corporate-owned practices (and even some privately-owned practices) report they are working in awful conditions, and forced to deliver substandard healthcare so the practice can break even. 'If you feel like you are cut short, or your GP doesn't follow up appropriately, it's because of the funding model,' Burrell says. The fee you pay to visit your GP only covers part of the cost of running a clinic and employing the doctor. Hunter's article is a case study on Green Cross, a publicly listed corporate group buying up practices. 'Clearly, running general practices is profitable for Green Cross,' Hunter writes. How are they making it work? Hunter's analysis shows Green Cross medical centres reduced the number of doctors employed, and increased the number of patients per doctor between 2020 and 2024. GPA members report the same thing: to make ends meet, practices are pushing up patient numbers and reducing doctors. This means if you want to see a GP, you're going to have to wait longer, or take a nurse appointment instead. Hunter also talks about capitation, something that GPA is campaigning to change. Capitation is a funding system where the government pays a practice a certain amount of money per person enrolled. This system does not take into account the quality of care delivered, how many doctors are available, or even whether those enrolled patients can get an appointment. 'As you can imagine, this leads to very perverse situations,' Burrell says. 'There are lots of practices simply just taking the piss out of the funding system and exploiting a loophole for profit. 'They've got massive patient lists and one or two doctors supported by overworked nurses, and patients then need to rely on emergency departments and overpriced urgent care facilities when they can't get an appointment. 'Meanwhile, the clinics that are trying their best to deliver quality, timely healthcare are losing money hand over fist.' In Hunter's article, Green Cross responds by saying changes should be made so more capitation funding goes directly to clinics instead of getting tied up in administration costs. GPA's stance is that the capitation model is not fit for purpose. 'Sure, increasing capitation funding is better than nothing,' Burrell says. 'If clinics can get more money they can theoretically hire more doctors and make more appointments available. But the perverse incentives will still be there.' The best thing for patients, he says, would be a 'nice, simple system where GPs are paid for the real healthcare they deliver'. About General Practitioners Aotearoa General Practitioners Aotearoa (GPA) is the only independent organisation exclusively representing the voices of doctors working in general practice. We represent GPs who are clinic owners, employees, contractors and trainees. We are member-funded and receive no government money. GPA formed after the demise of the New Zealand Medical Association to independently advocate for GPs.
The Star
14-05-2025
- The Star
Limpopo pharmacist released on bail after alleged R1 million medical aid fraud
A Limpopo pharmacist, accused of a significant medical aid fraud scheme costing GEMS nearly R1 million, has been released on bail. A Limpopo pharmacist accused of orchestrating a brazen medical aid scam that cost the Government Employees Medical Scheme (GEMS) nearly R1 million has been released on R5 000 bail. According to Limpopo police spokesperson Colonel Malesela Ledwaba, GEMS opened a fraud case in April 2024 against a 40-year-old suspect. This followed allegations that the man approached medical aid members, promising them cashback and Green Cross shoes in exchange for their details, which were later used to submit fraudulent claims. Ledwaba revealed that Tinyiko Gift Mangolele, the owner of a pharmacy in Malamulele, went as far as unlawfully using the identities of unsuspecting medical doctors to file fraudulent prescription claims. These deceitful actions were carried out without the doctors' knowledge or approval, exploiting their professional credentials to orchestrate an elaborate scheme that further deepened the extent of the scam. 'Furthermore, Mangolele, the owner and director of a pharmacy at Malamulele, used the information of two medical doctors without their permission to claim medication that needed the doctors' prescription.' Ledwaba further stated that, 'Through intensive investigation conducted, it was further established that other members of GEMS never consulted with the doctors but claims were made on their behalf.' For four long years, the pharmacy owner carried out a calculated scheme, relentlessly defrauding the medical aid and siphoning off vast sums, causing a devastating financial blow to GEMS. 'As a result, the Medical Aid suffered a total loss of nine hundred and ten thousand rands (R910,000) between January 2018 and September 2022,' Ledwaba said. He further revealed that, following a meticulous investigation, the suspect was finally apprehended by members of the Provincial Commercial Crime Unit in the Malamulele policing area on May 12. The suspect is set to make his second appearance at the Giyani Specialised Court on 29 May, while police investigations into the matter continue. The Star [email protected]
IOL News
14-05-2025
- IOL News
Limpopo pharmacist released on bail after alleged R1 million medical aid fraud
A Limpopo pharmacist, accused of a significant medical aid fraud scheme costing GEMS nearly R1 million, has been released on bail. A Limpopo pharmacist, accused of a significant medical aid fraud scheme costing GEMS nearly R1 million, has been released on bail. A Limpopo pharmacist accused of orchestrating a brazen medical aid scam that cost the Government Employees Medical Scheme (GEMS) nearly R1 million has been released on R5 000 bail. According to Limpopo police spokesperson Colonel Malesela Ledwaba, GEMS opened a fraud case in April 2024 against a 40-year-old suspect. This followed allegations that the man approached medical aid members, promising them cashback and Green Cross shoes in exchange for their details, which were later used to submit fraudulent claims. Ledwaba revealed that Tinyiko Gift Mangolele, the owner of a pharmacy in Malamulele, went as far as unlawfully using the identities of unsuspecting medical doctors to file fraudulent prescription claims. These deceitful actions were carried out without the doctors' knowledge or approval, exploiting their professional credentials to orchestrate an elaborate scheme that further deepened the extent of the scam. 'Furthermore, Mangolele, the owner and director of a pharmacy at Malamulele, used the information of two medical doctors without their permission to claim medication that needed the doctors' prescription.' Ledwaba further stated that, 'Through intensive investigation conducted, it was further established that other members of GEMS never consulted with the doctors but claims were made on their behalf.' For four long years, the pharmacy owner carried out a calculated scheme, relentlessly defrauding the medical aid and siphoning off vast sums, causing a devastating financial blow to GEMS. 'As a result, the Medical Aid suffered a total loss of nine hundred and ten thousand rands (R910,000) between January 2018 and September 2022,' Ledwaba said. He further revealed that, following a meticulous investigation, the suspect was finally apprehended by members of the Provincial Commercial Crime Unit in the Malamulele policing area on May 12. The suspect is set to make his second appearance at the Giyani Specialised Court on 29 May, while police investigations into the matter continue. The Star
