CHILL out Chicken Littles — that’s my message to the public, welfare groups, politicians and doctors with respect to the $7 copayment for a GP consultation announced in the federal Budget.
I have not witnessed such an avalanche of expertise and prophesy since the soothsayers of the Y2K bug, SARS (severe acute respiratory syndrome) epidemic and Global Financial Crisis — or are they in fact the same soothsayers?
When I went to medical school I was taught to take a thorough history, then look, listen and feel before coming to a diagnosis.
The reaction to the copayment reminds me of how many younger doctors and emergency departments seem to practise these days — “Did I hear the word headache? Straight to the CT scanner.” Never mind if the patient with the headache was trying to solve the Rubik’s cube or had tonsillitis. Knee-jerk investigations and diagnoses have become way too common.
And so it is with the copayment idea and reactions.
Modern soothsayers hear the words “money” and “patient” in the same phrase and suddenly ejaculate the diagnoses of “unfair”, “deaths” and “unaffordable”.
Old dogs like me have seen these tricks before from the politicians and the soothsayers. When I take the copayment history, I see that Bob Hawke trialled it too. I see other countries like New Zealand have introduced copayments without the sky falling and that government spending on health in Australia has been growing faster than inflation.
When I look — keeping in mind that I live and work in one of the poorer areas of NSW — I see patients on welfare and low incomes every day who are already paying for pharmaceuticals, allied health services, complementary medicines and occasionally some quite bizarre devices and services they think are related to health.
When I look at the politicians and soothsayers opposing the copayment, I have found an uncanny resemblance to those calling for a carbon tax. Just as a price on carbon may make people respect and value the environment more, would not a price on GP visits make them value and respect their primary health care more?
When I listen to disadvantaged patients I have not heard as much hysteria as that of the soothsayers and non-government politicians.
For the 20 years I have worked in the public hospital system, I have listened to administrators constantly talk about the unsustainability of supplying services for free. More importantly, I have yet to listen to anyone who really understands the full extent of the copayments, rebate cuts and redirected funding of medical research.
The copayment is only one of about 70 changes to health funding and regulation in this Budget, so the last part of the examination is the “feel”.
I feel that the world will not collapse with a copayment. Just as Prime Minister Tony Abbott’s predictions when Opposition leader of the calamities of a carbon tax that did not eventuate, nor will Labor Opposition leader Bill Shorten’s dire prophesies for the copayment.
I feel that this debate will twist and turn for a few months more, as it passes through the Parliament, Department of Health and opinion polls. Let’s wait and see what the final outcome really is.
I feel a rebate cut will occur whether or not the copayment gets up. Accordingly, doctors should prepare for this in whatever way suits their practices and ethics.
I feel emergency departments and ambulance services will, out of necessity, have to address the longstanding problem of what to do with low triage category patients. If the states do not match the copayment, hospitals will choke with non-urgent cases.
I feel that the copayment will reduce trivial presentations to GPs, and will force GPs to be more accountable and thorough, which should lead to higher standards.
And I feel Joe Hockey should order the printing of a $7 note.
Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.