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Consumers and copayments: implications for health and Medicare

Speculation that the federal government is to introduce a general practitioner copayment into Medicare arrangements persists. Whatever the basis of such speculation, the spate of commentary and media reports feeds a sense that the time for change in Medicare is upon us: a recognition that the status quo is under strain for political, economic and health system reasons.

The suggestions for reaping payments from patients include a widely applied $6 copayment, a means-tested copayment that would vary depending on the patient’s concession eligibility, and a 15% cut to Medicare rebates for general practice patients in inner metropolitan areas. Such proposals heighten the tensions facing the government in its hunt to reduce spending without hurting patients or, God forbid, voters.

In an important sense, this is a welcome development. The debate about a sustainable health system is one that failed to flower during the last health reform foray. Now, at least, the community is being encouraged to consider the personal implications of rising health care costs.

The Consumers Health Forum (CHF) this year commissioned health costs researcher Jennifer Doggett to examine copayments. Her report found, among other things, strong evidence that copayments result in decreased access to health care, with no evidence for overall cost savings.1 Similarly, a study into the 2005 increase in Pharmaceutical…