GP co-payments? Don’t save on primary care

Don't save on primary care

As the saying goes: a fool and his money are soon parted. We’ve all paid for super clinics, the PCEHR, Medicare Locals, phone lines – you name it. Unfortunately, all these ideas have yet to bear fruit. Some say we should have spent our precious health dollars more wisely, especially in the current climate of ever-increasing health care costs.

Many GPs warned that spending too much money on these and other (non-proven) novelties would eventually come back to bite us. I tend to agree. For example, instead of building expensive, non-viable super clinics, we should have improved access to care by expanding existing GP infrastructure.

So, it was only a matter of time before the headlines appeared: “Australia ‘running out of money’ for Medicare: Hockey”, or: “Health Minister Peter Dutton opens door to GP co-payment”.

The government is putting the knife in general practice: Medicare rebates are still frozen and now there’s the idea of GP co-payments. This will be another missed opportunity to further improve the health of Australians. If people would defer a visit to the GP because of co-payments and end up in hospital, health care costs will go up instead of down (I have been told a visit to the GP is about ten times cheaper than a visit to the emergency department).

Prevention is better than cure. AMA president Steve Hambleton said in The Australian: “The big drivers in health care costs are not spending in general practice; it’s actually tobacco, it’s alcohol, it’s over nutrition (…) We need to make sure we continue to get access to GPs so we can do that health promotion and prevention and keep people out of the expensive part of the health system.”

We know that investing in general practice pays off in many ways. Let’s hope policy makers will listen this time.

7 thoughts on “GP co-payments? Don’t save on primary care

  1. Nice article Ed. A different spin I’ve been thinking about for some time, is whether patient contribution to their own healthcare improves compliance / adherence etc. I’ve often wondered if paying for something, even a little bit helps people value it more than something received for free. Of course for the people who truly can’t afford such a contribution, there is no question. But for those who can I just wonder whether it might be of overall more benefit because of the increased ownership and buy in to something they have directly contributed to (as against indirectly via taxes). Anyway just a thought.
    Good blog

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    • Thanks for your comment Jocelyn; good point indeed. I just hope gap payments will never replace annual indexation/ adjustment of Medicare rebates, as this will affect access to care.

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  2. Dear Edwin,

    Great article. I agree with your premise.

    Regarding individuals valuing the services they receive from the GP more with co-payment, we should recognise that this is a complex question. We should recognise that many GPs already privately bill.

    The co-pay places a barrier for patients seeking health care. In a sense, it does ask patients to be more mindful of the care they seek to receive. We are asking patients to make a decision on whether their perception of the health problem is of greater value than the cost of the co-pay (in addition to all the other intrinsic barriers to seeking health care).

    However, this financial barrier is regressive – it is likely to be irrelevant to someone who has a higher income and we’ll. We know this from experience – practices in high income postcodes tend to have the highest private billing fees. In an area like the lower North Shore of Sydney, this is the case even though there is absolutely no shortage of GPs.

    On the other hand, people who are sick or of low income, the co-pay represents a much greater barrier. The assumption that individuals will necessarily prioritise their longer term health over other immediate concerns is clearly false. Creating a system that implicitly turns health seeking into a moral virtue (i.e., a co-pay will make patients more “responsible”) is ideologically driven and unhelpful. We should be much more concerned with a health system that delivers patient meaningful outcomes.

    At local practice levels, it may be that private billing and/or co-payment might be good solutions. It is almost certainly not going to be case if we apply this universally.

    Yours sincerely,
    Michael

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  3. Pingback: Comment: GP co-payments? Don’t save on primary care | Michael Tam

  4. The concern I have is that the government will decide to means test the Medicare Levy and charge more to those “who can afford it”, but keep the reduced private healthcare rebate low (per the Labor changes).
    Surely if I have private insurance that covers me for most things, I should have a lower Medicare levy, but less access to “free” healthcare in the public system?

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