Wellington student Isla Forbes says she delayed seeing a GP because of the cost, and ended up with severe bronchitis.

One in nine Kiwis are not getting the GP care they need because they cannot afford it, Ministry of Health survey figures show.

The latest New Zealand Health Survey estimates more than 500,000 people have unmet healthcare needs because of the cost of a GP visit.

The figure has remained constant since 2011, and Royal New Zealand College of General Practitioners president Tim Malloy warned the risks of patients avoiding doctors' visits for years could result in greater inequity in healthcare.

CHRIS SKELTON / FAIRFAX NZ Tim Malloy, president of the Royal NZ College of GPs, says many of those missing out on care are probably those who need it most.

"There might be increased early mortality, increased complexity, and increased expense to the system as they end up in hospitals when primary care would have prevented that."

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He said the level of investment in primary care had eroded to the point at which additional costs were being passed on to patients who simply could not afford the fees.

SUPPLIED Peter Moodie, who chaired a working group on Very Low Cost Access funding, says the current model leaves many low-income patients out in the cold.

"This is in some instances a significant access barrier, particularly for those who are the most deprived, and these are people who are probably most in need of healthcare."

He blamed the problem on what he said was an annual funding gap of about $45 million, created by a funding formula based on enrolment numbers, rather than on the number of times a practice saw its patients.

"The formula they use to correct for each year is fundamentally flawed," he said.

JOHN BISSET/ FAIRFAX NZ Labour health spokeswoman Annette King says people will end up sicker, and cost more to treat in the long run, through a lack of Government commitment.

The Primary Care Working Group, which contributed to a 2015 report to Health Minister Jonathan Coleman on funding, found the current model resulted in almost as many non-high-needs patients receiving subsidised care as high-need ones.

That left many low-income patients out in the cold, according to working group chairman Peter Moodie.

"The funding should follow the patient, not the practice," Moodie said.

MARION VAN DIJK/ FAIRFAX NZ Health Minister Jonathan Coleman has acknowledged about half of those receiving subsidised GP care are not low-income patients, and about the same number of low-income patients are not benefiting from cheaper visits.

"The minister read the report and said he thought it was very good, but at that time he wasn't going to take any action on it. That was met by surprise from a number of doctors."

The Very Low Cost Access (VLCA) scheme subsidises general practices in which 50 per cent of the enrolment is classed as high-need – defined as being either Maori or Pacific ethnicity, or people living in the most deprived conditions.

Figures procured under the Official Information Act by the Labour Party show the average cost for patients in a VLCA practice this year is $15.27, compared with $40.71 for regular practices.

Labour health spokeswoman Annette King said the 2014-15 NZ Health Survey found the number of adults missing out on GP visits because of cost was between 473,000 and 531,000.

"Last July the minister acknowledged the problem, then failed to put in a budget bid to get any additional funding fix the issues, even though Treasury encouraged him to do so.

"Many New Zealanders will end up sicker, and cost more to treat in the long run, through a lack of commitment."

FUNDING INCREASE

The Ministry of Health said a total of 4.35m were enrolled with GPs, and about 16.4m general practice visits were made each year. Primary care funding had increased by $230m over the past eight years.

Coleman said in a speech to the college of GPs in July that 1.3m patients benefited from lower fees through VLCA, paying a maximum of $18 a visit.

He acknowledged: "However, around half are not low-income patients, and conversely around the same number of low-income patients who attend non-VLCA practices don't get cheaper visits.

"The fundamental problem is that it's difficult to move resources away from patients already receiving them ... At the same time, shifting funding would significantly disrupt existing business practice models.

"The bottom line, though, is that I'm always open to engagement with the sector on the path forward ..."

PAYING THE PRICE

Wellington student Isla Forbes, 20, is one of an estimated 80,000 of her age group for whom price stopped her seeking care.

"I had a cough for about a month and it began to get really really bad, but ... I couldn't afford it," she said on Thursday.

"I started to get a rattly chest to the point I couldn't breath without it rattling."

When she finally went to a doctor, an urgent X-ray showed she had severe bronchitis.

All up, the experience cost her more than $160 – almost as much as her weekly survival budget of $170.

"As a student I couldn't be forking this out. I need to eat," she said.