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Audit ideas would put health care ‘out of reach’: AMA


Patients would be hit with a $15 co-payment to see their GP, while medicines would cost an extra $5 and the states would be “encouraged” to introduce a charge for people going to public hospital emergency departments under recommendations made by the National Commission of Audit.

In a report that proposes radical changes to the structure of health funding and entitlements, the National Commission of Audit has recommended that patients face higher upfront costs for care and treatment, that health insurers be allowed to charge higher premiums for smokers, that nurses, pharmacists and other professions be allowed to expand their scope of practice, that the pharmacy industry be substantially deregulated and that the rollout of the National Disability Insurance Scheme be slowed.

AMA President, Dr Steve Hambleton, condemned the proposals, saying they would put health, medical and pharmaceutical care out of the reach of families.

Dr Hambleton said the Commission’s proposed health system undermines the principle of universal access to health care.

“It is clear that the Commission’s recommendations have been put forward by business leaders and bureaucrats with no input from people with health and medical expertise,” Dr Hambleton said. “It is a health system designed by bean counters for bean counters. It puts saving money ahead of saving lives.”

While the Abbott Government has not committed to implementing any of the Commission’s recommendations, Treasurer Joe Hockey and Finance Minister Mathias Cormann said its report was “one important input” into the Government’s Budget deliberations.

“We will continue to review and consider the recommendations and advice as we continue to pursue the necessary structural reforms of the Budget and Government spending programs,” the Ministers said.

But the Government has all but confirmed it will introduce a patient co-payment. Both Mr Hockey and Health Minister Peter Dutton have talked in recent days of the need to get those with the capacity to make a greater contribution to the cost of their health care.

The Commission has recommended patients be charged a $15 co-payment for their first 15 visits to a GP each year ($5 for concession card holders), and $7.50 ($2.50 for concession card holders) for every visit after that.

In addition, the co-payment for PBS medicines should be raised by $5 to $41.90, and the general patient safety net should be lifted by almost $200 to $1613.77, the Commission said. Concession card holders would be liable to a $2 co-payment once the safety net threshold of $360 was reached.

Dr Hambleton said the proposed would shift “more and more health costs on to patients, including the most vulnerable – working families, the elderly, and the chronically ill.”

“The new high co-payment proposal for GP visits would see sick people abandon or delay visits to the doctor, which would ultimately cost the health system more, as these patients would eventually require much more expensive hospital treatment,” he said.

Since the idea of GP co-payments was most revived early this year, there has been mounting speculation that private health funds might offer policies to cover the extra cost, but the Commission explicitly called for such a move to be prohibited.

The AMA and other health policy experts have also warned of the risk that a GP co-payment might force more patients to seek treatment in public hospital emergency departments.

To address this, the Commission suggested that the States be “encouraged” to introduce a system of emergency department co-payments for “less urgent conditions”.

In addition, the Commission has recommended that GPs who want to bulk bill patients be prevented from waiving the co-payment.

In measures that would specifically hit higher income households, the Commission proposed that the better off be blocked from Medicare subsidy for “basic” health services, be precluded from access to the private health insurance rebate, and that the General Extended Medicare Safety Net threshold be raised to $4000.

In a radical break with the principle of not allowing health insurer to cherry pick members, the Commission said the community rating system should be relaxed to allow health funds to charge higher premiums for members who are smokers or have some other lifestyle health risk factors.

It has also recommended measures that are set to incur the wrath of the major health professions.

It has called for greater competition in pharmacy by scrapping the industry’s ownership and location rules, and has urged that the scope of practice for occupations such as nurses and pharmacists be extended – both recommendations which are highly controversial and likely to trigger a strong backlash.

Dr Hambleton said the recommendation was a serious concern for the AMA, as were a number of other proposed measures including:

·         a merger of Health Workforce Australia and GPET with the Department of Health and Ageing, which would undermine the capacity to undertake essential medical workforce planning to ensure the community has access to the right number of doctors in the right places;

·         winding back changes to the medical indemnity insurance industry that were implemented by Prime Minister Tony Abbott when he was Health Minister; and

·         scaling down the National Disability Insurance Scheme.

Other recommendations include giving the Health Minister the authority to add and remove medicines from the PBS schedule, allowing drugs approved by “certain overseas agencies” to be added to the PBS without obtaining separate TGA approval and to slow the roll-out of the NDIS.

Dr Hambleton urged the Government to reject the Commission’s recommendations and instead talk with the medical profession about reforms that would make the best use of available health funds.

“The only good thing about the Commission’s health recommendations is that they will be easy for the Government to reject them – and the AMA will be urging the Government to do so,” the AMA President said.

Adrian Rollins