Government Prescription Fees Lead To Amputations, Heart Attacks: Pharmacist Survey

An "inhumane" government prescription fee contributes to serious health issues including stroke, heart attack, sight loss, failed kidneys, breathing problems, mental health crises, and amputations, according to a new survey of 150 community pharmacists around New Zealand.

Pharmacists reported the "patient co-payment" fee - usually $5 per item up to $100 per year per family, for people aged 14 and over - also contributes to uncontrolled cellulitis, asthma and eczema, including for teenagers.

"The government prescription fee is causing widespread distress in our communities, and it needs to be removed immediately," says Vicky Chan of the Prescription Access Initiative, a group of pharmacists who co-organised the survey in March. "It is outrageous the government is imposing a preventable and heavy burden on people’s wellbeing, and on the health system."

The report mentions patients who underwent amputation due to diabetes complications after they didn’t pick up insulin prescriptions due to cost: one "was a sole earner for the family and he has lost his foot and has lost his job."

"Our survey gives insight into how the government fee prevents access to healthcare, even for people who have gone to their doctor for help," says Chan. "The system is letting them down."

Recent University of Otago research has already separately shown the prescription fee significantly increases the number of people who are admitted to hospital every year.

The new community pharmacist survey also indicates that prescription fees may contribute to family stress, including abuse and violence; can make patients feel ashamed and whakamā; and necessitates impossible choices.

"In one case I have heard a parent say to their child, ‘It’s either medicine or food, we can't afford both’," reported one pharmacist.

Pharmacists surveyed called the fee "inhumane" leading to "soul destroying" consequences. Mental health patients are among those prevented by the fee from accessing medicines. "Since with each [untreated] episode of schizophrenia, the impact of the illness gets progressively worse, it was heartbreaking to watch," reported one pharmacist. Organ transplant patients and patients with infections are also affected: "A young man [was] unable to pay for his flucloxacillin prescription. He ended up in hospital on iv antibiotics for a few days," reported another.

Pharmacists reported the fee made patient interactions more difficult - which can lead to worse health outcomes - even with those patients who found the fee affordable. "We want to advise on health but instead we’re discussing costs with everyone," says Chan. "Removing the fee would be a really useful response to the cost-of-living crisis."

Community pharmacies assist where they can, but fiscal management takes time and resources away from healthcare, says Chan. "Writing off tens of thousands of dollars in patient debt every year - which some of our community pharmacies do - is unsustainable and puts pharmacy services at risk."

However, in areas where the government temporarily removed prescription fee after Cyclone Gabrielle, pharmacists reported the waiver had immediate community health benefits. "Without the fee, their patients were happier, less stressed and more engaged, and everybody picked up all their prescriptions," says Chan. "These on-the-ground, immediate, real-time effects give us hope. They show our vision of a more equitable and effective health system due to fees-free prescriptions is well within reach.

"Removing the patient co-payment prescription fee for everyone is the easy thing to do and the right thing to do for community wellbeing and to ease the burden on our over-stretched health system."

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