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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
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3 factors only seem important –
1] we have a government that is expressing its needs to teach lessons to the public.
2] copayments will reduce numbers attending for acute care. There will be fewer consultations. A little money may be made by the government. But health will suffer.
3] The scheme won’t in the end save any money.
I support mixed billing where appropriate. I have been told by older GPs that this was the case prior to Medicare (or Medibank, I suppose). Low or no charge for the indigent/poor/very sick etc, and normal fees for those able to pay.
Having an argument about an either/ or answer is infantile. The question is quite obviously far more sophisticated, requiring a more sophisticated answer than copayment: yes or no, and impact on patients’ health care yes or no.
By simple definition universal health care does not equal to free health care. They may be equated for the purpose of supporting one’s argument. In practical terms, free health care may be required ( AKA bulk billing) or at least see to be required to ensure universal health care.
We have a copayment system. It’s called a Medicare rebate, being 75% or 85% of the scheduled fee. I welcome correction, but isn’t that how the system was created, before being, shall we say, altered based on suggestions from a colleague or colleagues in Sydney, in the 1980s?
If a $6 copayment were introduced, would this not mean the loss of the bulk billing incentive payment, worth some $8.45 or thereabouts?
And far more importantly, what is the simplistic, emotive, and publicly contentious issue of a $6 copayment distracting us from in the proposed changes to Medicare? I would suggest that this is Government 101.
A “$6” co-payment would end up being a lot more to cover the cost of implementing it; as this practice bulk bills, to start collecting payments would involve employing more staff, which means greater costs to the practice.
Currently welfare recipients in Australia live below the poverty line and taking into account the percentage of income a co-payment of $6 would represent does not present the full picture. How many of us could live on $510 a fortnight? We need to take into account the real cost of medical care – what it costs to travel to see the doctor; what the prescription will cost afterward; will follow up be required etc. Remember $6 is the equivalent of a meal, so for some people if the choice is between paying for a doctors visit or putting that money toward their shopping budget, feeding yourself/your family is going to win. I believe copayments have the potential to negatively impact on health care for people on low income, especially with respect to preventative health measures such as immunisation, pap smears and skin checks, and that it could therefore result in increased costs to the system as a whole
I completely agree with the concept of a copayment, in both GP practices and emergency departments. It’s a conflict for GPs and the AMA on the one hand to cry out about a $6 copayment, and on the other hand argue that Medicare rebates haven’t kept up with inflation and thus that payment of a gap is necessary (the latter of which I support). If GPs were really concerned about the impact on patients then they wouldn’t be charging gap payments at all. A small financial contribution will incentivise appropriate access to healthcare and improve efficiency by avoiding spurious consults (that’s the problem with things when they’re free – people tend to overuse, and in some cases, abuse them). This is even more important in the emergency setting to provide a disincentive to people who present at hospital for non-emergent problems.
Healthcare costs in Australia are unsustainable in the long term and it’s very reasonable that people pay a small contribution towards their own healthcare. $6 is a very small price to pay, and given that Australians receive absolutely world class healthcare there should be no qualms about paying it. Even the unemployed receive a minimum of $510 a fortnight from centrelink, and the DSP pays a minimum of $766 – a $6 GP visit would represent 1.2% or 0.8% of that budget, respectively. People don’t think twice about paying for their hair to be done, topping up their text allowance on their mobile phone or buying another packs of smokes – why should there be a second thought about paying for their health?