A staggering number of Kiwis are behind on their vital health screenings, with the cost of living and price of care a significant barrier for many people.
Delaying these appointments means some people's illnesses could pass the point of being curable, which one doctor finds very concerning.
The latest Tend Health Index revealed more than half of Kiwis are only visiting the doctor when they absolutely have to. Notably, 54 percent of Kiwis aren't up to date with their melanoma skin checks or have never had a skin check to begin with (51 percent).
Furthermore, 38 percent of Kiwi parents don't know if their children are up to date with all their recommended vaccinations, 26 percent of women are behind on their cervical smear screening, 22 percent of women aged 40 and over are behind on their mammogram screening, and 30 percent of men aged 40 and over are behind on their prostate screening.
Dr Mataroria Lyndon, director of health equity at Tend, is worried this means too many New Zealanders are racking up health debt through missed procedures, screenings, and specialist appointments.
He said the COVID-19 pandemic is part of the reason behind screening programs and planned care being delayed, but there's also the problem of convenience and accessibility of health care. There are also issues with wait times at GPs to get an appointment, which is adding to the challenges.
Barriers to care
In the Tend Health Index survey, one question the 1500 participants were asked is what stops them from seeing their GP as often as they should. The largest proportion (33.6 percent) said going to see a doctor is simply too expensive.
One person who took part in the survey said the current high cost of living is delaying her from going to follow-up appointments.
Alex* was prompted to get a skin check after a close family member delayed getting a changing mole looked at and later died because of it. While Alex got the all-clear after her first check, she's now "far overdue" for her next appointment and is getting chased by the clinic.
"I'm acutely aware of the danger in delaying regular checks, but unfortunately the cost of living coupled with the knowledge my skin is fine and I've observed no changes since my last check means it's far down the priority list," Alex told Newshub.
"Instead, I complete a self-check, knowing I have any freckles/moles on record already and if anything changes in the next few years I can go back to the clinic for an expert opinion."
Other barriers survey respondents reported included not being able to get an appointment when it suited them (22.4 percent), they couldn't see their preferred GP (17.5 percent), and they didn't have the time (12.2 percent).
If people do get behind on their health screenings or vaccinations, there can be several snowball effects and a higher number of people can be put at risk.
The first is with vaccinations. Dr Mataroria Lyndon explained there is more of a risk of outbreaks if fewer people are immunised, which was seen with measles earlier this year and in 2019.
"By not having the vaccinations on time and not having a higher rate of childhood vaccinations, you increase the risk around what are vaccine-preventable diseases like measles," he told Newshub.
"There is literally greater risk for communities and for individuals or people when they're not immunised because the benefits of immunisation aren't just for yourself, it's actually creating that herd immunity."
In terms of screening programmes, Dr Lyndon said if someone falls behind on the likes of cervical screening, then they could be at a greater risk of not detecting cervical cancer as early as they could. This means it is less likely to be treatable or it is more advanced and aggressive than if it was found earlier.
How access to care can be improved
Dr Lyndon is optimistic fewer New Zealanders will miss check-ups in the future if outreach services and digital-first models are more widely available. The new ways of taking health care out to the community we learnt during the COVID-19 pandemic - such as telehealth - are solutions we could take forward, he said.
"It's about prevention, so trying to keep people well. And secondly, not being the ambulance at the bottom of the cliff," Dr Lyndon said.
For patients where there are preventative or proactive health opportunities, they can be kept well if they stay up to date with their care.
He hopes to see more digital and outreach services since it benefits not only patients, but the health system and workforce too.
Māori and Pacific communities in particular benefit from outreach programmes, he said, with barriers to care such as not having appropriate transport or being unable to take time off work often being issues.
Health care being culturally appropriate is also a contributor to access, Dr Lyndon said, given that sometimes it isn't just the test or the vaccination itself but the way in which it's delivered and who from that really matters.
Then there's the task of even remembering what health checks or vaccinations you need. Pointing to the fact that 38 percent of Kiwi parents don't know whether their children are up to date with vaccinations, Dr Lyndon admitted it is difficult to keep track of it all.
"It's really hard to actually keep up with what are those milestones - I've got a childhood vaccination schedule myself to keep track of," he said.
"So those health promotion campaigns so that people are aware in terms of the importance of screening and vaccination [are really important]."
Dr Lyndon recommends that while health providers need to reach out to patients to make sure they're aware of vital upcoming screenings, patients can also have these conversations with their GP. He said patients can ask their healthcare providers about anything from when they're due for a bowel screening, which of their children's vaccinations are coming up, and when they should get checkups for conditions that are in their family history.
"Having these conversations with your health provider grows your understanding, and that means that you can also be supported to keep on top of your health."