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Co-payment shelved…for now

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The Federal Government has shelved controversial legislation to introduce a $7 GP co-payment amid dire predictions hospital emergency departments and ambulance crews would be swamped by patients seeking to avoid the fee.

With no sign that opposition to the proposal among key cross-bench senators is softening, Health Minister Peter Dutton early this month pulled plans to introduce the co-payment Bill, raising doubts that it will go before Parliament this year.

In a statement, a spokesman for Mr Dutton told The Australian Financial Review that the Government already had a number of important pieces of legislation to pass, and “there is plenty of time for this legislation to be debated before its commencement”.

The Government’s plan, under which a $7 co-payment would be levied on all GP, pathology and diagnostic imaging services from 1 July next year, has been vigorously opposed by Labor, the Greens, the Palmer United Party and several independent senators, and has failed to garner public support.

An Essential poll conducted earlier this month found that voter attitudes to the idea have hardened since the Budget – opposition to the idea swelled to 66 per cent, up from 50 per cent in May.

Adding to the Government’s tough sell, documents obtained by NSW Labor show the NSW Health Department anticipated that hospital emergency departments would have to treat an extra 500,000 patients if a $6 GP co-payment were introduced, and in Victoria paramedics told a Senate inquiry they expected an increase in serious cases if there was a co-payment because patients put off seeing their doctor to dodge the charge.

AMA President Associate Professor Brian Owler told Fairfax Media the NSW Health analysis showed the co-payment would undo recent hard-won improvements in emergency department waiting times.

“Putting another 500,000 people into that system is going to mean all of those gains are going to be lost, and we are probably going to end up in a worse position than when we started,” A/Professor Owler said.

NSW Opposition leader John Robertson said the NSW Health estimates showed the co-payment would “smash” the health system.

Despite the setbacks, Mr Dutton remains publicly upbeat about striking a deal with independent Senators to have the co-payment passed by Parliament.

While refusing to disclose details of his discussions with key cross-bench Senators, Mr Dutton said that “there is going to be the ability for us to do a deal on the co-payment”.

“If we want to make our health system sustainable we have to make tough decisions,” the Minister said. “We have to get this right, and I’m confident that we can negotiate a situation which makes Medicare more sustainable.”

The ambiguous statement leaves open the possibility the Government might accept changes to its co-payment model to secure the support it needs to have the measure become law.

But the discussions may also involve trade-offs that could lead to even deeper cuts to spending on primary care and dumping more health costs onto individuals and families.

Mr Dutton told reporters that the AMA, like the Government, “want[s] to see a sustainable Medicare”.

But the AMA has repeatedly said that although it does not oppose co-payments in principle, it rejects the Government’s model.

And AMA President Associate Professor Brian Owler said figures produced by the Australian Institute of Health and Welfare showed there was no basis to Mr Dutton’s claims the co-payment was needed because Government spending on health was growing unsustainably.

The AIHW reported that total health expenditure grew by a record low 1.5 per cent in real terms in 2012-13, underpinned by a 2.4 per cent slump in Commonwealth Government spending.

A/Professor Olwer said the figures “really make a mockery of the fact that the Government’s been claiming that health care expenditure is out of control”.

“The Government’s used this as a narrative in the lead-up to its Federal Budget, saying that health care expenditure is out of control, and it’s used that to justify the introduction of the GP co-payment. Now, there is no justification for a GP co-payment, let alone the $5 [cut] for the patient’s Medicare rebate.”

There is mounting concern about the sort of deals the Government might strike with independent Senators to achieve health savings.

A/Professor Owler warned that even if the Government’s plan for a $7 co-payment for GP, pathology and diagnostic imaging services was knocked back by the Senate, it might still receive backing for its $5 cut to Medicare rebates, leaving both patients and doctors worse off.

“What we are concerned about is the potential trade-offs and deals that might be done that might mean that we do not have a co-payment, but are still stuck with a cut to the Medicare rebate,” A/Professor Owler said. “That would mean patients are worse off [and] that there is no support for GPs or investment in general practice.”

Mr Dutton said he was “working behind the scenes with the independent Senators”.

Adrian Rollins