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Tougher Stance On GP Patient Eligibility Proposed

Fuseworks Media
Fuseworks Media
Tougher Stance On GP Patient Eligibility Proposed

General practices will be required to see patients' passports to check they qualify for funded- healthcare if a recommendation to that effect is signed off at PSAAP next month.

A PSAAP working group tasked with revising PHO enrolment requirements has produced a draft document being circulated ahead of the next full PSAAP meeting scheduled for 10 November.

Looking for national consistency

The document, which aims to bring national consistency to PHO enrolment processes, contains a recommendation that practices be required to "sight the appropriate evidence" of eligibility for publicly funded care when enrolling patients, PSAAP chair Neil Stiles says.

"Practices are recommended to request appropriate proof, whether that's a residence permit or work permit or that sort of thing," Mr Stiles says.

Patients are eligible for free or subsidised health and disability in New Zealand if they are New Zealand citizens, permanent residents, hold a work permit for two or more years, or meet other criteria set out in the 2003 Eligibility Direction of the Minister of Health.

At present, the Ministry of Health website states "a person may be asked to show proof that they meet the eligibility criteria".

However, Mr Stiles says not all practices check.

Cross matching NHI numbers

Ultimately, the working group wants eligibility to be determined centrally through cross-matching of NHI numbers and immigration status, and for ineligible patients not to receive funding in the first place.

In the meantime, however, the group has recommended all practices check patients' eligibility for a year, after which the process would be reviewed.

Whether the burden of proof for eligibility should fall on general practices until an electronic system is developed was a sticking point for the working group, which took three months to produce the final draft ready for circulation.

Onus should be on patient

General Practice New Zealand (GPNZ) chair Fiona Thomson, a member of the working group, says the group worked hard to reach a compromise on the matter.

GPNZ wanted patients to make a declaration of eligibility on the enrolment form so that the onus of proof is on them, Ms Thomson says.

"We want the patient themselves to sign the declaration and for them to be liable."

As it stands, she says, DHBs can technically deduct from PHOs' capitation funding any money previously issued for patients who aren't eligible.

The draft document contains a sample PHO enrolment form for all practices to use.

It includes a patient declaration of eligibility and a standardised consent clause for use of a patient health information.

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