Front line rejects GP copayments

A LACK of relevant data and a failure to consult should consign the proposal to impose a $6 GP copayment to the rubbish heap, according to GPs, health policy experts and the AMA.

Two articles published online by the MJA present the consumer and GP reactions to the idea of the copayment in the run up to the federal Budget on 13 May.

Adam Stankevicius, CEO of the Consumer Health Forum Australia, said the proposal signalled “a further lurch towards a two-tiered regime that provides world’s best specialist and hospital care to those with the means, while those without may wait in pain or die”. (1)

Professor Christopher Del Mar, professor of public health at Bond University in Queensland, wrote that although a copayment might save a small amount in the short term it would “impoverish us all — not just by the downstream increase in specialised health care and the harm done by missed serious illness and missed opportunities to properly reassure patients, but morally as well”. (2)

Their views were supported by Sydney GP Dr Linda Mann, who told MJA InSight that the idea of a means-tested $6 copayment was not only “problematic” but “odd”.

“This is an attack on the concept of universal health care”, Dr Mann said. “Medicare is not and was never designed to be a two-tier system.”

She said the idea of copayments was problematic, particularly as bulk-billing patterns differed from doctor to doctor.

“We have about 14 doctors in my practice. I charge about 50% of my patients. Other doctors may bulk-bill more or less than that, depending on their experience and the kinds of patients they are seeing”, Dr Mann said.

Jennifer Doggett, a research fellow at the Centre for Policy Development, an independent public interest think tank, agreed, telling MJA InSight that a lack of relevant data made any change of policy about Medicare difficult to justify.

“We have no idea who is paying what for their health care”, Ms Doggett said. “There are no data collected about who pays what for what in the [Medicare] system.”

She said this lack of data meant there was no way of identifying people who were struggling to meet their health care costs and no way of creating a safety net for them.

“Copayments are going to make that situation worse. The priority should be to start collecting that data”, she said.

While it was reasonable that as a society Australians should pay more for health care as a whole, it should not be paid by sick people at the point of service, Ms Doggett said.

Health economist Dr Sue O’Malley, from the Australian School of Advanced Medicine at Macquarie University, Sydney, suggested three questions to consider when deciding if a copayment might improve efficiency in primary health care — will it add value to GP advice, therefore increasing compliance; will it decrease waiting times; and will it motivate patients to be “better prepared” for their visit to the GP, by stockpiling ailments rather than paying for a second visit.

Dr Mann said there seemed to be an unspoken expectation that when a patient pays for health care “they somehow become intelligent about when they need to see a doctor and what kind of care they need”.

“Price is not a marker for people’s ability to judge their own health care needs. The idea that people make choices about health care relative to cost is just not true”, Dr Mann said.

AMA president Dr Steve Hambleton last week called on the federal government to “engage in meaningful consultation” with professionals on the front line of the health system. (3)

“Making policy on the run is no way to equip the health system to meet future needs”, Dr Hambleton said.

“All the speculation ahead of the Budget is about GP copayments, freezing Medicare rebates, means testing, and now a charge for patients who go to emergency departments with minor ailments.

“These proposals are targeted at the wrong end of the health system. They would produce disincentives for people to see their doctor, and they would create loads of new red tape for medical practices.

“There is already means testing in the health system through processes such as the application of the Family Tax Benefits to Medicare Safety Net thresholds. The new proposals would put a means test on top of a means test.

“The GP co-payments idea could actually lead to increased costs to the health system, and should be ruled out immediately”, Dr Hambleton said.

1. MJA 2014; Online 14 April
2. MJA 2014; Online 14 April
3. AMA 2014; Online 9 April