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$7 MBS co-pay fails to pass the means test

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There has been so much focus on the $7 co-payment measure announced in the May Budget that the community seems largely unaware that the Government is also proposing that Medicare rebates for GP attendances, along with rebates for pathology and diagnostic imaging services, will be cut by $5. Every other MBS item will have also effectively be cut because of the freeze on indexation.

I’m not quite sure how Health Minister Peter Dutton thinks he is strengthening general practice. The Government is simply withdrawing significant support for patients to access frontline care and shifting more costs on to them.

In addition, the Government seems to have given little thought to the costs that will be imposed on practices as they endeavour to collect the $7 co-payment.

GPs visiting residential aged care facilities will be expected to collect $7 from each patient they see. Some practices will require more equipment, a larger reception desk, and more staff to process payments, manage bad debts and do the banking. There will be additional processing costs with EFTPOS fees and transaction costs. It will mean having to run a cash float and all the additional security concerns, cost and headaches that go along with that. 

For one period of illness there will be multiple $7 co-payments that have to be collected. This will be particularly difficult for pathologists, as they rarely see the patient. If GPs are expected to collect the $7 on their behalf, that will only add to the administrative burden for practices.

With this proposal, the Government is asking all patients to contribute to their health costs.

If patients cannot afford this, the Government seems to think that GPs should act as some sort of de facto safety net. From 1 July next year, every time we waive the MBS co-payment we will be taking at least a $5 cut in our pay for the service – if a patient holds a concession card or is younger than 16 years the hit to income will be $13 to $16.10.

The Government is also going to exclude the $7 paid out-of-pocket from counting towards the new Medicare Safety Net! The Government’s revised Medicare and Pharmaceutical Benefit Scheme safety nets will do less to catch those with large health care costs.

While the thresholds for the Medicare Safety Net will be reduced and streamlined, the proportion of out-of-pocket expenses that count, and the benefits payable, will be decreased. When it comes to medication, the thresholds are also set to be increased every year.

Patients with concession cards or children younger than 16 years will be expected to pay $70 out-of-pocket before the MBS co-payment will be waived. The Government appears to have given little thought to the needs of families or the pressure this will put on lower socio-economic groups.

This situation becomes even worse when several family members are sick at one time, or they need to make multiple visits, undergo numerous tests, and get several prescriptions, all in a couple of days. For people on benefits, cash flow will be a real problem.  

If the Government hopes to get its co-payment measure through the Senate it is going to have to construct a better model.  One that supports our sickest and most vulnerable, and the practitioners who care for them.

The AMA stands ready to assist the Government to get this right, to make sure there is better support for our vulnerable patients and for those who are at the frontline of their medical care.