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21 Jan 2014

A proposed $6 patient co-payment for bulk billed GP and emergency department visits is an ill-conceived measure that fails to address the long-term causes of rising health costs, the AMA has warned.

As the Federal Government searches for ways to slow growth in health spending, concerns are mounting that it may adopt the patient co-payment suggested by Terry Barnes, a former health adviser to Tony Abbott, in a submission to the high-powered National Commission of Audit.

But AMA President Dr Steve Hambleton and a chorus of other health and economics experts warn that the idea would be, at best, a short-term expedient likely to come at the cost of an even greater national health bill in the future.

 Mr Barnes, in a report for the Australian Centre for Health Research think-tank, said a $6 co-payment for each of the first 12 bulk billed visits to a GP each year would, if GP rebates were frozen as an incentive to take the co-payment, save the Government $750 million over four years and act as a deterrent for those seeing doctors unnecessarily.

“I make no apology for suggesting a modest price signal at point of access, provided that it doesn’t deter people from going to the doctor,” Mr Barnes wrote in The Australian, but added “world-leading health care comes at a price, and if small co-payments help some people reflect before they call on that system, surely that’s not a bad thing.”

He said the $6 amount was “the equivalent cost of a hamburger and chips or a schooner of beer”, and the Commission needed to consider such “tough but fiscally fair” measures, not just for GP services, but for “health and other welfare infrastructure”.

While the Government has made no formal response to the proposal, in an interview with Fairfax Media, Health Minister Peter Dutton said “it would be foolish to rule out ideas people are putting forward”, and flagged the need for an overhaul of the Medicare system.

Mr Dutton said Medicare spending was growing at a rate that could become unsustainable, and there needed to be change.

The annual Medicare bill has climbed in the past decade from $8.1 billion to $17.8 billion, and the frequency of GP visits has jumped from 4.3 per person in in 2003-04 to 5.59 between April 2012 and March 2013.

“The threshold question is whether people want the health system of today strengthened for tomorrow, because at the moment the health system is heading to a point where it will become unmanageable,” the Minister said.

One of the many problems identified by critics with the co-payment proposal is a lack of clarity about what problem it is primarily intended to address – is it perceived GP over-servicing or growth in health spending?

Either way, Dr Hambleton warned that targeting GP services for savings was a false economy that would lead to greater costs down the track.

General practice was the most efficient part of the health system, he said, helping minimise the number of people who ended up needing far more expensive hospital or chronic care.

Dr Hambleton said it was unclear that there was much of a problem with unnecessary use of GP services, and the greater concern was putting barriers in the way of people seeking relatively inexpensive GP treatment for health complaints that might develop into much more expensive and serious problems if not treated early.

“The main problems we’ve got with our health system are the growing amounts of chronic disease and our ability to treat lots of diseases that we couldn’t treat that well in the past,” he said.

“Our concern is that both people who need to go,” he told ABC radio.

Dr Hambleton said a particular concern was that a co-payment would deter people from going to their doctor for preventive health reasons, which were likely to be viewed as discretionary.

“That is the thing that is going to save us money in the long-term. 

“If we’re really thinking about long-term health care costs, we’ve got to talk about health maintenance, keeping people out of hospital.

“We should be targeting things like tobacco, alcohol, over-nutrition and under-exercise. That’s where the real payback’s going to be.”

Grattan Institute health economist Professor Stephen Duckett said the proposed co-payment would have a disproportionate impact on the poor, and would likely result in people deferring both necessary as well as ‘unnecessary’ visits to their doctor.

As Fairfax economics correspondent Peter Martin put it, “the charge would apply to all visits to the doctor, both serious and frivolous. And we are not skilled at deciding what’s frivolous. That’s why we go to the doctor.”

Writing in The Australian Financial Review, Professor Duckett said encouraging people to defer necessary visits to the doctor will only increase “downstream costs, as problems put off become more expensive to treat later.”

“Although a $6 slap-down of consumers may be fiscally attractive, it does nothing to change the fundamentals of the health system, and is a distraction that does more harm than good,” he said.

In its submission to the Commission of Audit, the AMA recommended a raft of changes to cut down on red tape and improve the efficiency and productivity of GP services.

It called for the PBS authority prescription system to be axed, for doctors to be allocated a single Medicare provider number, for Medicare payment processes to be streamlined, and for Medicare Locals to be reformed.

See also GP co-payment no way to cut health costs by Dr Lesley Russell.

Adrian Rollins



Published: 21 Jan 2014