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Dunedin's largest medical practice says it can no longer afford to offer free health visits to a group of young patients.
Since 1996, Mornington Health Centre has provided visits free to patients aged under 18.
From January, the practice will charge those aged 6 to 17 (inclusive) $10 for nurse and GP visits.
About 3500 young patients are affected.
Practice manager Barbara Bridger said Mornington had been unable to negotiate an agreement with the Southern District Health Board and Southern Primary Health Organisation to continue the ''special service''.
''This decision has not been made lightly and has become necessary as the government funding sources available to the practice have been severely reduced in recent years.''
About $200,000 a year was needed to retain the free visits.
Mornington was an independent primary health organisation (PHO) until a merger with Southern PHO nearly two years ago.
Since losing PHO status, Mornington had to scrap many services, including those aimed at diabetes prevention and at-risk youth.
''After spending the past two years trying to continue to provide these services, the practice has succumbed to financial pressure and now its free under-18 policy will be cut back to free under-6s only,'' Ms. Bridger said.
She said some parts of New Zealand had local ''flexible'' funding models to support services such as Mornington's under-18 visits.
''If parents can't afford to bring kids to the GP, then the health of our kids will only deteriorate,'' she said.
Southern PHO chief executive Ian Macara said Mornington was making a ''business decision'' to charge the patients, which he respected.
Flexible funding arrangements allowing primary health money to pay for services like Mornington's were not available in the southern region, he said.
Methodist Mission Dunedin chief executive Laura Black said the move was ''a great shame'' as it reduced access to healthcare.
The health system needed to be reformed to help providers like Mornington maintain a much-needed service, Ms. Black said.
Removing free GP visits meant more young people would become acutely ill, and end up in Dunedin Hospital emergency department, she said.
''People are going to have to get sicker to get that help.''
The southern health board frequently cites the need for the primary sector to be better utilised to reduce attendances at its overstretched Dunedin Hospital emergency department.
However, yesterday, in an email, portfolio manager Adele Knowles said the change was unlikely to affect numbers attending the emergency department.
The board was keen to introduce a flexible funding model, but not necessarily to pay for under-18 health visits.