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Co-payment on edge amid fears it could jeopardise Indigenous health gains

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AMA President Associate Professor Brian Owler has warned that recent gains in health of Indigenous Australians will be jeopardised under the Federal Government’s plans for a $7 co-payment for GP, pathology and diagnostic imaging services, which would effectively rip millions of dollars out of Indigenous health care.

As the Federal Government continues to assess an alternate co-payment model proposed by the AMA which would protect vulnerable patients while putting a value on GP services, A/Professor Owler kept up the pressure for a fundamental re-think by highlighting it’s potentially disastrous effect on Aboriginal health.

Speaking at the conclusion of a four-day visit to Indigenous communities across the Northern Territory, A/Professor Owler said the high level of disadvantage in these areas meant Aboriginal health services would have no option but to absorb the co-payment themselves, adding millions of dollars to their costs and forcing cutbacks on services vital to sustaining improvements in Indigenous health.

“There’s just no way that people in these communities are going to pay $7 to visit a GP, let alone for pathology and diagnostic imagining,” A/Professor Owler said, meaning that if Aboriginal health services wanted to keep on caring for their communities they would have to absorb the co-payment themselves, adding $14.10 to the cost of each consultation.

Health services visited by the AMA President estimated that absorbing the co-payment on behalf of their patients would cost each of them up to an extra $750,000 a year, meaning that they would have to cut services and might need to axe staff.

A/Professor Owler’s warning came amid signs the Government is willing to contemplate changes to its co-payment proposal in order to secure vital support for the Budget measure in the Senate.

Senior Government ministers have alluded to the possibility pensioners and other disadvantaged patients may be exempted from the co-payment following discussions with key cross bench Senators.

Asked whether the Government would contemplate such exemptions, Mr Hockey told ABC radio that “we are prepared to discuss these things [with crossbench Senators]”.

 Indications that the Government may be softening its position came during a week in which both Treasurer Joe Hockey and Health Minister Peter Dutton held meetings with independent and minor party Senators to discuss the co-payment and other Budget measures.

A series of gaffes by the Treasurer, including comments last week that poorer people do not drive as much as the wealthy, and a call by former Treasurer Peter Costello for the $7 co-payment to be dumped, have helped blunt the Government’s Budget sales pitch.

But Prime Minster Tony Abbott said on the weekend he was confident that the “vast majority” of the Government’s Budget measures would be passed.

“I am confident that, perhaps with an adjustment here, perhaps with an adjustment there, the vast majority of our Budget measures will get through,” Mr Abbott said.

Mr Dutton said last week that the Government’s proposed $7 co-payment model was “a reasonable package”, but “we are discussing, obviously, in good faith, proposals that are being put to us by the AMA, by the independent Senators, and we’ll let that process run”.

Neither the AMA nor the Government has publicly divulged details of the alternate co-payment model proposed by the Association, though A/Professor Owler has repeatedly stressed it involved protection for vulnerable patients, and would not deliver the level of savings provided by the Government’s model.

Mr Abbott has flagged the possibility of some protection for nursing home residents, and there has been speculation of broader exemptions for pensioners and others on welfare.

But Mr Dutton last week indicated that was not being contemplated by the Government, at least at this stage.

“When we talk about blanket exemptions…you’re talking about almost nine million Australians out of a population of 23 million…so it’s very hard to provide blanket exemptions,” he told Sky News Australia. “But we are considering looking at the cost implications and the health implications of the proposals that people have put to us.

“It’s not to say that the Government’s got a predisposition to anything that’s being proposed. It’s saying that we are looking at the proposals that have been put to us and…if we think it adds value to what we’ve put on the table, we’re happy to have those continued discussions.”

So far, the Government is struggling to secure the numbers it would need to ensure the passage of its $7 co-payment through the Senate. Labor and the Greens are opposed to the measure, and Palmer United Party leader Clive Palmer has so far indicated his party’s three Senators would also vote against the proposal, as would independent Senator Nick Xenophon. Other key crossbench Senators Ricky Muir and John Madigan have also expressed opposition to the measure.

A/Professor Owler said that the AMA did not oppose patient co-payments, but could not accept the Government’s model because of its likely effect on the vulnerable, particularly Indigenous Australians.

He said important progress was being made in improving Indigenous health, particularly in raising the birthweight of Aboriginal babies, and the co-payment threatened to undermine such gains.

“We’ve made tremendous gains in terms of life expectancy and dropping infant mortality and the child death rate for Indigenous Australians,” he told ABC News. “[But] if you lose funding you have to cut services. We can’t afford to lose frontline staff. Many of our Indigenous health services don’t have enough staff as it is.”

“What we’ve seen, talking to doctors on Bathurst Island, what they want is more funding for antenatal care and early childhood intervention so we can actually give kids the right start to life.

“If we do that we know they’re much more likely to attend school and perform at school and reach year 10 or hopefully year 12.

“Then they can go out and get a job and break the problems we have in terms of social determinants of health.”

Adrian Rollins