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$6.15 co-payment an investment in quality care: AMA

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Children and concession card holders would be exempted from paying a co-payment for GP services under an alternative model put by the AMA to the Federal Government and publicly released late last month.

In a plan designed to protect vulnerable patients while injecting much-needed funds into general practice and putting a value on quality primary health care, the AMA has proposed that a $6.15 co-payment apply to most GP services, with Government paying the fee on behalf of children younger than 16 years and concession card holders.

Under the AMA’s plan, the co-payment would not apply to residential aged care and home visits, chronic disease management services, health assessments and mental health treatment items, while child immunisation would be covered under the blanket exemption from the co-payment for children younger than 16 years.

In addition, the AMA has called for a two-year delay on the Government’s proposal to impose co-payments for pathology and diagnostic imaging services, pending detailed consultations and assessments with professional and consumer groups.

AMA President Associate Professor Brian Owler said the Association’s model, which was presented to the Government in late July, was underpinned by two important principles – protecting vulnerable patients and supporting quality general practice.

A/Professor Owler said the Government’s $7 co-payment plan had failed dismally on both counts – it would fall disproportionately heavily on the sickest and most vulnerable, and the $5 cut to Medicare rebates it involved would make many general practices, particularly those in disadvantaged areas, unviable.

The Government has failed to articulate and clear and internally-consistent rationale for its proposed $7 co-payment, which would apply to all GP, pathology and diagnostic imaging patients.

The plan has been alternately presented by the Government as a way to ration access to health care by sending a ‘price signal’ to patients, as a means to support medical research (co-payment revenue is to be directed to a Medical Research Future Fund) and as a way to improve Commonwealth finances by helping defray the rising cost of Medicare.

But A/Professor Owler said the AMA proposal would provide the Government with only modest savings, of around $66 million – a fraction of the $3.5 billion claimed by the Government under its proposal.

Instead, he said, through its co-payment model, the AMA sought to address what it saw as a secular decline in support for general practice that was undercutting quality health care and would eventually increase the incidence and severity of preventable disease and exacerbate the pressure on the health system.

At the heart of these concerns is the long-term deterioration in the value of Medicare rebates for GP services.

A/Professor Owler said Medicare rebates had increased by an average 2.48 per cent a year in the past 30 years, completely outstripped by growth in the costs of providing quality medical care such as rents, training, staff costs, insurance, and equipment, and had been frozen for the past two years.

He said the erosion in the value of Medicare rebates had been exacerbated by the surge in bulk billing, to the extent that more than four out of every five patients seen by the nation’s GPs are bulk billed.

“The Medicare Benefit Schedule does not represent the true quality of quality primary health care,” the AMA President said. “It does not value the vital role of general practice in the health system.”

Under the AMA proposal, GPs would receive the $6.15 co-payment, injecting an extra $580 million into general practice, according to Government modelling.

A/Professor Owler said the much-needed injection of funds could relieve some of the competitive pressure on GPs to bulk bill and cut consultation times.

“If we continue to go down the path that we are, with 81 or 82 per cent of GP services being bulk billed, then what will happen is that we have this competition where the bulk billing signs do go up, and people are forced to bulk bill on the basis of competition,” he said.

“At the end of the day, that’s a bad thing for patients, because [it means] those practices are essentially just bulk billing and they have to adjust, eventually, the amount of time that they spend with patients, [which means] they can’t do the prevention, [the] chronic disease management.

“What we want to do is actually give them a break from that bulk billing competition, allow them to actually charge a fee that recognises more of the services that they are providing, and actually allows them to do the important work of prevention and chronic disease management that actually we want our GPs to do for the sustainability of the health care system.”

In its model, the AMA has effectively re-badged the $6.15 bulk billing incentive for metropolitan GP services ($9.25 in rural and regional areas) as a direct co-payment to GPs.

The AMA proposal includes a hefty incentive for GPs to charge the co-payment.

Where they charge the schedule fee plus the co-payment, GPs will receive the full A1 schedule rebate (currently $37.05 for a level B consultation), plus the co-payment (for a total payment of $43.20).

But if a GP decides to waive or reduce the co-payment, they would only be eligible for the A2 level schedule rebate (currently $21 for a level B consultation), meaning they would receive just $26.15 – a stiff $17.05 financial penalty.

A/Professor Owler said that there would inevitably be patients who were older than 16 years and did not hold a concession card but who had a reduced capacity to pay, such as low income families or those with complex and chronic conditions. He said people in these circumstances were known to their GP, and under the AMA model the family doctor would continue to look after them as happened under current arrangements.

The AMA President said the AMA was open to suggestions on ways to improve its co-payment model, not least from the Indigenous community.

“The AMA model is an attempt to support quality general practice,” he said. “It aims to allow GPs the opportunities to spend more time with patients to provide preventative health care and chronic disease management, and to place a value on the valuable service they provide.

“The focus is on the quality of the services, and this benefits the GP, the patient, and the broader health system.

“The AMA model is all about maximising the benefits of high-quality primary care and general practice, keeping people well, keeping people out of more expensive hospital care.”

Adrian Rollins