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Copayments for general practice visits

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To the Editor: While the points made by Del Mar1 would have their proponents and opponents, it is a pity that the debate is constrained by Australia’s obsession with universal fee-for-service medical care.

Surely we should be rational and have “horses for courses”. If there are socioeconomic areas (whether urban or rural) where most people would be seriously deterred from seeing a general practitioner by a $6 (or $7) copayment, is it reasonable or logical for medical practice in those areas to be remunerated on a fee-for-service basis?

Fee-for-service has a purpose — to make patients bear some responsibility for their use of medical services.

Such impoverished areas could instead be served (and in many countries are served) by salaried GPs or by GPs paid per patient on their books (capitation).

Health insurance mitigates the fee-for-service burden on patients but, if excessively generous, leads to the “moral jeopardy of insurance”, where the patient spends at will, knowing that the insurer is picking up the tab.

Is it not time for Australia to give up this obsession with universal fee-for-service? It has proven to be unbearably expensive for the nation, aggravated by Medicare’s and health funds’ (backed by federal subsidy) re-imbursements.

Let’s find a…