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29 Apr 2014

The Federal Government has all but confirmed that patients will be charged a co-payment for GP services, despite AMA warnings that it is an ill-conceived idea that will ultimately add to the nation’s health bill.

Treasurer Joe Hockey said last week that a GP co-payment was “in the mix” of measures to be included in the May Budget as the Government sought ways to curb what it viewed as unsustainable growth in Medicare spending.

“The fact is that Medicare is growing at twice the speed of the economy,” Mr Hockey told ABC radio. “We all have to make contribution because nothing is for free. Nothing can remain for free.”

In a speech in which he sought to frame discussion of the forthcoming Budget, the Treasurer released National Commission of Audit analysis showing that some of the Commonwealth’s most costly programs were also the fastest growing, including welfare, health, education and defence.

According to Commission projections, spending on the Medicare Benefits Schedule will virtually double in the next 10 years to $38 billion, while expenditure on hospitals will almost treble to $37.8 billion and the cost of the Pharmaceutical Benefit Scheme will swell from $9.3 billion this financial year to $15.6 billion in 2023-24.

“The Report makes it clear that Australia has a serious spending problem,” Mr Hockey said. “More use of co-payments should be made to encourage some moderation in demand for Government-provided goods and services. Nothing is free. Someone always pays.”

Speculation about a co-payment had already been fuelled early last week by report in The Australian that the Budget would include a $6 charge for patients using GP services, capped at 12 visits a year, meaning patients would face an extra annual cost of no more than $72.

While refusing to confirm the report, Health Minister Peter Dutton said that the better off should not expect to be able to see a GP for “free”.

“I want to make sure that we can strengthen Medicare, but we’re not going to do that by giving free services in the hundreds of millions each year in a country like ours,” the Minister said.

Mr Dutton said the Government would “take care” of those who could not afford higher medical charges, “but, at the same time, people on incomes like mine, or a reporter on $300,000 or $400,000 a year, should we expect to go to the doctor for free? That’s a reasonable question to ask.”

The AMA has been a vigorous critic of suggestions there be a GP co-payment, warning that the measure – which it has been estimated could save $750 million over four years – is likely to substantially add to the nation’s long-term health bill.

AMA President Dr Steve Hambleton has 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 said.

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.”

Dr Hambleton said that, instead of fuelling speculation, the Government should be consulting with doctors, who deliver medical services on a daily basis and have the knowledge and experience to identify how best to use scarce health funds.

Instead, in an opinion piece in the Consumer Health Forum journal Health Voices, Mr Dutton said major changes to the health system were “imperative”, singling out Medicare in particular for reform.

Likening Medicare to a Holden Kingswood, the Minister said it was conceived of in “a different world”, and was badly in need of modernisation.

He talked approvingly of the possibility of involving private health insurers in the provision of primary care, “particularly those with chronic disease and considerable needs for medical care or treatment”.

“If an insurer can provide additional support to a doctor, why would we resist that?” Mr Dutton asked. “It has the potential to save a lot in human and financial terms.”

The Opposition has pledged to oppose a GP co-payment, which Labor Leader Bill Shorten condemned as a “GP tax”.

Shadow Health Minister Catherine King warned the measure would force more people to go to hospital emergency departments for treatment, increasing pressure on the public tertiary care system.

“If you are trying to reform the health system, this is not the way to go about it,” Ms King told the ABC.

The Government is expected to release the findings of its National Commission of Audit on Thursday. The Federal Budget will be handed down on 13 May.

Adrian Rollins

Published: 29 Apr 2014