Temira Kemp with her toddler Noah, 22 months. Temira says it is difficult to access free medical care for her son.

From conception to the first day at school, in theory it shouldn't cost anything to keep you and your children healthy. In theory. In reality hidden costs and surcharges undermine the promise of free health care.

About 44,000 sick or injured children failed to see a doctor last year because of the cost, according to a new Ministry of Health report.

Some doctors are putting surcharges on what is meant to be free or low-cost healthcare for children, prompting calls for standardised pricing.

Caught in the middle: Child advocate Dr Nikki Turner says kids can't chose if they have money or not.

A survey of medical centres across the country found GP fees for children ranged from free to $70, with postcodes often decising the bill.

Children's doctor visits, prescriptions, ambulance rides, and ACC surcharges are increasingly putting pressure on patients' wallets as surcharges creep up.

The Sunday Star-Times hit the streets and found people had no idea what they should paying.

Child poverty advocate and GP, Dr Nikki Turner, said doctor visits and maternity care was a mixed bag with costs varying between regions.

"Kids shouldn't be kept caught in the middle . . . kids can't chose if they have money or not."

The mix of Government funding and private charges has lead to a overly complex payment system, she said.

While some GPs are overcharging, doctors should not cop all the blame because there was also some nasty Government policy clouding the issue, she said.

She called for universal healthcare for children, such as free prescriptions, but drew the line at greater price regulation for doctors.

Wellington mum Temira Kemp said finding free medical care for her son Noah, aged 22 months, proved a nightmare.

She rang four different suburban clinics, known to provide free GP visits for preschoolers, but all had closed their books to new patients.

She was forced to use an inner-city doctor that cost about $30 each consultation.

It made a big difference when that doctor also started providing free care late last year, she said.

"I go to the doctor more now," she said. "If Noah is looking sick, I now take him doctor on Friday and get a script in case he needs antibiotics for the weekend. Whereas before I might leave it and see if he gets better."

During her pregnancy she said she did not know doctor visits were theoretically free and was stung with $70 bill for her first GP appointment.

Prescriptions are generally free, especially antibiotics, but she must pay extra for eczema cream for her son.

Green Party health spokesman Kevin Hague said the cost of healthcare was increasingly coming from the personal purse rather than Government pockets.

"The reality for so many is that those services are increasingly not accessible for the people who need them most. I think that is shameful for a first-world country."

Often families are confused about different charges and do not realise the government paid large sums to subsidise medical care, he said.

"There are rules and there are maximum fees, but within those maximum fees the cost will vary quite considerable. The public doesn't see that complexity. They just see a confusing picture."

The cost on the poor was deepening the country's underclass, he said.

"What we are seeing is this grey area, where people expect from their Government comprehensive and universal health services in return for the taxes we all pay. Under this government we are going further away from that ideal."

Ministry of Health statistics revealed the number of children aged under-6 receiving free healthcare fell in the last financial year.

In 2011, the Government boasted that 87 per cent of children received free doctors' visits under the zero fees for under sixes scheme.

But the latest figures show this had fallen to 83 per cent of children in 2011-12 financial year, according the Ministry of Health children's report.

"Our kids are missing out on essential health services. Where is the priorities here?" Hague asked.

He called for a standardised surcharge on medical fees, but said it should be negotiated with doctors rather than imposed.

It was not just children bearing the cost. One in seven adults failed to see a doctor last year due to the cost.

PRICE TAGS FOR YOUR CARE

Ambulance $80*

Fall off a ladder and receive a free trip to the hospital. Wake up with heart pain and you will will be billed up to $80.

The Government funds 80 per cent of St John ambulance service – the shortfall is covered from fundraising and the part-charge, which ranges from $65 to $80 depending on your region. If the DHB orders you an ambulance, they foot the bill. If a friend calls an ambulance for you, you foot the bill.

Wellington residents are lucky enough to still have a free ambulance service. Living up to its name, the Wellington Free Ambulance is the only emergency service that won’t cost you. Injuries caused by accidents are also covered under ACC.

Visitors to New Zealand pay the largest amount: $757 for a St John Ambulance callout.

*A non-accident related emergency in Auckland.

After hours care $54*

The statistics tell a grim story. One in 20 children – or about 44,000 – missed out on after-hours services in the past year due to cost says the Health Ministry.

Rates are higher for Maori and Pacific children. Cost prevented one in 10 Maori children from using after-hours services in the past year.

After mounting public pressure, the Government announced free after-hours care for under-sixes from June 2012, at a cost of $7 million a year.

Prior to this, after-hours fees for children aged under six cost up to $100 per consultation and an estimated average fee of about $17.

Parents spoken to did not realise the fee should be waived for their preschoolers.

Sky Scott, who has four children, said he did not know how much the doctor costs for his children.

However, he said New Zealand’s system is superior to the United States, where he is from.

‘‘If you want to have good doctors you have to pay for them. If you don’t pay for them, the doctors are going to go somewhere else.’’

*An after-hours appointment at Moorhouse Medical Centre in Christchurch for a casual patient aged 6-17. Children under 6 are free.

Maternity $90*

Maternity care is free for women from pre-conception to post-natal – but not according to women.

Two expectant mothers said it was a lottery as to whether you would be charged for doctor visits.

At one Auckland clinic, the doctors told a pregnant woman she received free care for only the first trimester of her pregnancy. Then she would be charged $50 per visit, or $90 if she was not enrolled.

Two other women also said medical receptionists often didn’t know what a pregnancy related appointment should cost and the fee varied between clinics.

Giving birth can also be costly if you chose an obstetrician.

If mother chooses to go private to avoid the trappings of the public health system, it will set her back about $3000.

There may also be charges for antenatal or childbirth education classes, and ultrasound scans. Private obstetricians and private maternity hospitals will also charge a fee.

*A GP consultation for a non-enrolled patient at a St Heliers medical clinic.

Prescriptions $5+

Prescriptions for children aged under six are supposed to be free, but parents are charged $5 for prescriptions, or more for eczema cream or Ventolin for asthma.

The price of prescriptions jumped $3 to $5 on January 1, but if your medicine is not fully subsidised you may face a bigger bill.

In the latest controversy, patients complained last week of paying $6 extra per week for a blister pack to hold their medications.

Labour health spokeswoman Maryan Street said the Government was playing dangerous games.

‘‘Making savings is one thing; threatening people’s lives is quite another.’’

Last year, 7 per cent of children missed at least one prescription due to the cost, according to the Ministry of Health.

The rate was similar across all age groups, including children younger than six years who qualify for free prescriptions.

Children living in poor areas were about three times more likely to not have their prescription filled as children in the wealthiest areas.

Green Party health spokesman Kevin Hague said he has heard of parents choosing between their children’s prescriptions due to cost.

‘‘A system that forces people into that heartbreak is just wrong and incredibly short-sighted.’’

Parents reported not knowing there was an annual $100 limit on a family’s prescription costs.

Childern's doctor consultation $21*

Free GP visits for children is merely a dream for many parents.

The Government subsidised up to $35 for GP visits, but doctors can add a surcharge to cover the difference.

Almost a half of parents (45 per cent) paid for their children to visit a GP in the past year, according to a the Ministry of Health children’s report.

An Auckland medical centre charges up to $35 for children aged under 6 and up to $60 for all other children.

But in Wellington many GPs are now offering free appointments to preschoolers.

Families are split on the extra charges. Auckland woman Annette Ogilvie said primary-aged children and preschoolers should receive free GP visits and prescriptions.

Dad-of-two Dan Buchanan said he didn’t know what the charges were for his children to visit the doctor, but he was happy to pay any amount for the sake of this children’s health.

The number of children under 6 receiving free medical care fell last year, despite a zero-free scheme pushing for free doctor visits.

*Of parents charged, the average cost was $21, according to the Ministry of Health.

Children's dental care $3000+

Dental care and surgery for children is free in New Zealand, but repair jobs will pull money from your purse.

A North shore parent said he paid more than $3000 to have two of his five-year-old daughter’s teeth repaired with caps, rather than opting for free tooth removal. Other parents also reported they went private to receive better dental care.

Freebies

It’s not all bad news. The country’s $14 billion health budget still has plenty of freebies on offer. Auckland resident Dianne Hill said the health system was superb in New Zealand. She said she was happy to pay an ambulance or GP subsidy. ‘‘You can’t just have everything for free.’’

What is still free

• Immunisation jabs for children

• A&E care

• School dental nurse

• Children’s eyesight and hearing checks

• Elective surgery - if you’re

willing to wait

• Plunket

• Healthline