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GP co-payment ‘not considered’ by Govt: Minister

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A Federal Government Minister has been forced to backtrack after appearing to rule out the introduction of a patient co-payment for GP services.

After declaring to the Senate on 20 March that that “the Government has not considered the introduction of a co-payment for Medicare services”, Assistant Health Minister Fiona Nash notably refused to repeat her assertion when questioned in Parliament four days later.

Asked on 24 March whether the Government was considering a co-payment for GP services, Senator Nash instead said, “My advice was that the Government had not considered the introduction of a co-payment for Medicare services”.

The backflip suggests that a co-payment or some other change to funding for GP services, such as tiered system of rebates based on means testing, remain under active consideration by the Government as it digests the findings of its Commission of Audit and constructs the 2014-15 Budget.

Senator Nash told the Parliament that “to assist the Government to provide subsidies for clinically necessary treatment and services through Medicare, the National Commission of Audit is charged with examining the scope for efficiency and productivity improvements across all areas of Commonwealth expenditure”.

That a patient co-payment for GP services is under examination was confirmed by a senior Health Department bureaucrat during a recent Senate Estimates hearing.

Dr Richard Bartlett, First Assistant Secretary of the Health Department’s Medical Benefits Division, told the hearing on 26 February that, “We have done a range of work over a long period of time about co-payments in the MBS. That work continues.”

Senator Nash’s comments follow months of speculation about the possible introduction of upfront charges for GP visits after former Coalition ministerial health adviser Terry Barnes proposed a $6 patient co-payment as a way to deter people from making unnecessary visits to their doctor.

Mr Barnes suggested the co-payment, matched by a similar charge for emergency department patients, as a way to help control rising health expenditure in a submission presented to the Commission of Audit by the Australian Centre for Health Research.

But the AMA said the co-payment proposal was not credible.

In a devastating critique, AMA President Dr Steve Hambleton said the idea was poorly conceived, simplistic in its analysis, riddled with logical flaws and wildly inaccurate in its conclusions.

In a submission to a Senate select committee inquiring into the Commission of Audit (an edited version of the submission is at: Flawed co-payment proposal does not stack up, p36), Dr Hambleton wrote that among its “very significant flaws”, the ACHR assumed that unless there was a policy change, GP service volumes would grow at an annual rate of 3 per cent – well above the annual average gain of 2.24 per cent experienced since the commencement of Medicare in 1984-85.

“By choosing a high-growth rate for the base case,” Dr Hambleton said, “ACHR has painted an overly optimistic picture of the scope for budget savings under their co-payment proposal.”

The AMA President said ACHR’s projections regarding the effect of a co-payment were also flawed.

He said that while imposing a co-payment might have a short-term “shock effect”, most households would absorb the cost and see their GP as before because health is regarded as a superior good.

The effect of the co-payment would be most visible and direct on those without the capacity to pay more, and any reduction in GP visits among the financially vulnerable would almost certainly result in a rise in more expensive, and avoidable, hospital stays.

Dr Hambleton said the ACHR managed the extraordinary feat of making co-payment savings estimates that were simultaneously too high and too low.

He said they were too high because of the simplistic assumption that the co-payment would be charged without an up-front reduction in nominal Medicare rebates.

Dr Hambleton said this was not credible, particularly in urban areas, where competition between GPs would make universal application of the co-payment “highly unlikely”.

He said the projected savings were too low because they underestimated that savings made from the GP fee freeze that was part of the proposal, and was likely to save the Government $1.1 billion over four years.

“It will be self-evident that rebate cuts of that order would represent a very significant reduction in Government support for patients needing to see a GP,” the AMA President warned.

Dr Hambleton said there was no evidence of widespread over-use of GP services and, rather than looking at co-payments, the Government should work with the medical profession on ways to better support GPs in their gatekeeper and preventive health roles.

A Fairfax Media/Nielsen Poll found that voters were evenly split on a GP co-payment, with 49 per cent in favour and 49 per cent opposed – though, as health policy expert Jennifer Doggett pointed out, caution should be exercised in interpreting the result given lack of alternative funding options presented to respondents.

But the Australasian College for Emergency Medicine is the latest to join the chorus of condemnation, arguing a co-payment for emergency department (ED) patients was a poorly conceived idea.

College President Dr Anthony Cross said ready access to emergency care was a fundamental part of the health system, and a co-payment would deter patients from seeking necessary care.

The College said there was very little evidence that patients were seeking emergency care inappropriately, and added that it would be impossible in practice to distinguish between patients who should and should not have attended the ED, for the purposes of charging a co-payment.

Adrian Rollins