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Co-payment may be put on bypass


Concerns are mounting the Federal Government may try to bypass Parliament and introduce its unpopular $7 patient co-payment by regulation in a desperate ploy to salvage a key plank of its Budget.

In a worrying sign that the Government intends to push ahead with the controversial measure even though it has little prospect of passing the Senate, the Department of Human Services has asked medical software providers to incorporate the charge in their products, according to a report in Pulse+IT Magazine.

The move follows the refusal by Health Minister Peter Dutton and Treasurer Joe Hockey to rule out circumventing Parliament and implementing the co-payment through changes to regulation.

And it comes amid speculation the Government will put the co-payment legislation on hold for the rest of the year to concentrate on other aspects of its legislative agenda, including the deregulation of university fees.

Asked during an interview on ABC’s Radio National whether the Government was planning to introduce the co-payment with legislation, Mr Hockey replied: “I am not speculating on what the outcome is”.

AMA President Associate Professor Brian Owler said it was quite feasible for the Government to cut Medicare fees by $5, which would in turn reduce the rebate by $5, thereby implementing the key savings measure in the $7 co-payment proposal.

But A/Professor Owler warned the Government risked incurring the wrath of the public if it behaved in such cynical manner.

“There was never a mandate to do this [introduce a co-payment], so actually trying to bypass the Senate would show complete contempt for the Senate and contempt for the Australian public,” he said. “To introduce this proposal, which is not supported by the Senate, [and] is not supported by the public, and try and bypass Parliament, is a very poor approach, a very cynical approach, to what is very poor policy.”

The Government is yet to introduce legislation for its co-payment plan into Parliament, where it faces almost no prospect at this point of being passed.

Labor and the Australian Greens have vowed to block the measure, and there is no sign that Mr Dutton and other senior ministers have been able to convince Palmer United Party senators to soften their stance opposing the co-payment.

A/Professor Owler, who met with PUP Senate leader Glenn Lazarus and Senator Jacquie Lambie earlier this month to discuss the co-payment, said he had been assured the minor party would not support the measure.

Aside from the legislative hurdle, the Government is also facing enormous practical challenges in implementing the co-payment, particularly if it wants it to begin on 1 July 2015.

One of the biggest headaches is working out how to track the number of co-payments made by patients who are concession card holders or children younger than 16 years.

Under the Government’s plan, all patients would be liable for a $7 co-payment on GP, pathology and diagnostic imaging services. But, in a gesture to patients from disadvantaged backgrounds, concession card holders and children younger than 16 years will only have to pay the co-payment for the first 10 services each year – an effective cap of $70.

But this will mean tracking patients as they move through the health system from general practice to pathology, diagnostic imaging and back again.

A/Professor Owler said this was a major issue.

“Clearly there are problems with implementing this policy,” he said. “The software is nowhere near ready. There is no way to track when a patient on a concession goes from a GP to a pathologist, [then] to have their x-ray, [and] back to the GP.”

The Department of Human Services has written to medical software companies advising them that “sites will need to check whether the patient has a concessional status, and may choose to charge a patient contribution at the point of service, as appropriate”, according to an email obtained by Pulse+IT Magazine,

But Medical Software Industry Association Chief Executive Bridget Kirkham told software companies had not yet been given enough information to act on the Government’s plan.

“There are still details to be worked out before we could consider going forward,” Ms Kirkham said.

A/Professor Owler warned the Government would be foolhardy to attempt to force the implementation of the co-payment in the next seven months.

“Implementation of this very poor policy is going to be very difficult,” he said. “I think it will be a disaster if they try to push ahead with some kind of proposal by 1 July 2015.”

Adrian Rollins