Zero Fees for Under-13s

From 1 July 2015, most general practices offer zero-fee visits for children under 13. Children under 13 no longer pay the $5 charge for each item of prescription medicine, though other charges may apply.

The Government announced in Budget 2014 that it would allocate $90 million over 3 years to implement the scheme, extending the ‘zero fees’ scheme already in place for children aged under 6.

DHBs are also required to ensure that children under 13 can access zero-fee after-hours care and prescription medicines within reasonable travel time (maximum of one hour).

General practices can choose whether or not to provide ‘zero fees’ to under-13s. Those that opt in receive an additional subsidy from the Government.

The changes are designed 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.

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.

Zero-fees coverage

96 percent of general practices with enrolled children aged 6 - 12 have opted in to the zero-fees for under-13s scheme, and 98 per cent of practices with enrolled under-sixes offer zero-fee visits.

All practices in the Very Low Cost Access scheme are required to offer zero fees to under 13s. As with the under-6s zero-fees scheme, opt-in for non-VLCA practices is voluntary, with decisions made at the individual general practice level. The Ministry has set up a regular monitoring process with DHBs to track coverage of the scheme.

Practices previously in the under-6s scheme have the option of remaining in only the under-6s scheme. From 1 July 2015, any practice choosing to opt into the zero-fees scheme can only opt into the under-13s scheme, covering all children aged up to 13.

Zero fees implementation

The terms of implementation for daytime access to free visits were agreed via the PHO Service Agreement Amendment Protocol (PSAAP) Group. The Community Pharmacy Services Operational Group (CPSOG) was consulted regarding removal of the $5 prescription co-payment.

Daytime zero-fee visits for enrolled under-13s are funded via capitation funding, with an additional subsidy paid to practices opting in. Utilisation rates for zero fees for under-13s have been modelled on existing utilisation rates in a range of practices, including those in high needs areas, as well as the experience of introducing zero fees for under-6s.

The General Medical Subsidy (GMS) rate for casual visits for 6–12 year olds remains unchanged, helping to incentivise enrolment with a regular practice and continuity of 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 one hour) to after-hours general practice and pharmacy for 95 percent of their enrolled population.

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