A chain of GP practices is asking patients to pay before they see the doctor because more and more people are skipping on their bills.
Green Cross Health is rolling out a policy to ensure people pay prior to their consultation across most of its 67 clinics nationwide, following an increase in patient debt levels over the past six months.
It says in the face of an ongoing cost of living crisis most GPs are facing the same problem.
General Practice NZ has told Checkpoint it was aware of GPs in high needs areas having to do the same.
"With a lack of government funding we're faced with making these tough decisions" - Andrew Tucker
Andrew Tucker from Green Cross Health said over the last six to 12 months they had seen an increase in the number of people who were not paying for their consults at the conclusion of seeing the doctor.
"Clearly the cost of living crisis is a key driver in this and that is putting pressure on families and communities - it also puts pressure on us and our teams," he said.
"It is something we haven't experienced before to this level but in order to be able to ensure that we're maintaining services, maintaining high quality care for our communities, this is a step we've had to take so that we can support our teams and support our staff who are working hard for our communities."
The organisation was seeing the problem right across the country, he said.
Green Cross Health had always had a policy of having a conversation with patients who were not able to pay about how they could help them with that, he said.
"The majority of patients are absolutely understanding of this move, and understand the reasons why we've had to do it. We've had a few patients who, this is a change for them and they're still coming to terms with that, but I've been really pleased with the support we've received from our patients overall."
Asked what happened if a patient turned up to see a doctor but could not afford to pay, Tucker said that in the first instance they would be triaged by a nurse who would talk to them about why they were there. The nurse would either then make a decision or get more information about their history from colleagues to determine whether or not they needed to be seen, he said.
"If it's an emergency then they absolutely are treated, there's no question about that. If it's not an emergency then one of the practice team would talk to them about how we can help them to make payment either by setting up a payment plan or some other arrangement so that we can treat them and they've got a way in place to make payment."
Sending patients who could not pay to the emergency department would not be the first choice, he said.
"Our hope is that we can work with patients, we can arrange a way for them to be able to pay. You know patients who are low income will often have a community services card which is a lower fee, so we absolutely want to be able to work with patients in the first instance to try and be able to support them."
Tucker said in an environment where government funding had not kept pace with the cost of running a practice and employing staff they had to make decisions that supported practices and looked after their employees.
Green Health Practices had always had a policy of patients paying on the day that they were seen by a doctor, but this just brought that forward slightly, he said.
"With a lack of government funding we're faced with making these tough decisions."
The organisation had been in discussions with Te Whatu Ora for some time around needing additional income for practices in order to be able to support care, he said.
The cost of a GP visit at Green Health Practices was a maximum of $19.50 with a community services card and on average $45-$55 without a card depending on where you lived, he said.