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Patients and GPs to be left worse off by co-payment

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The Federal Government’s move to impose a co-payment for GP visits will deter people from seeking necessary medical care and could leave doctors $13 out-of-pocket if they waive the charge for their patients, the AMA has warned.

Confirming widespread speculation that the Government would seek to push more of the cost of health care directly on to patients as it sought to hold down spending, the Budget included a $7 charge for GP consultations, pathology tests and diagnostic imaging services.

Health Minister Peter Dutton said the measure was necessary to help address what he said was unsustainable growth in Medicare expenditure, citing figures showing it had more than doubled to $19 billion in the past decade and was projected to reach more than $34 billion by 2024.

Mr Dutton said that, from 1 July next year, all GP patients – including those previously bulk billed – would be required to make a co-payment, with the funds raised to be directed to the Medical Research Future Fund.

The co-payment will apply to A1, A2, A11, A22 and A23 GP consultation items. It will not be applied to Chronic Disease Management items, health assessments and mental health items, or for services to Indigenous patients.

Budget savings worth $3.5 billion over five years will come from an associated measure to cut Medicare Benefits Schedule rebates by $5 for a standard GP consultation, with a similar reduction in rebates for out-of-hospital pathology services and diagnostic imaging tests.

Softening the blow for concession card holders and parents of children younger than 16 years, they will only be liable for the co-payment for their first 10 visits to the GP each year, and doctors will receive a Low Gap Incentive to hold the co-payment to no more than $7. For each subsequent visit, doctors will continue to receive the incentive if they provide their services free.

Only those visits where the $7 co-payment is applied count towards the 10-visit threshold. Those visits where there is no co-payment, or a smaller or larger co-payment is applied, do not count toward the threshold.

Furthermore, the 10 visit threshold includes pathology and imaging visits, so that the total co-payment exposure for concession card holders and children is $70 a year.

But, although the Minister implied the co-payment would be compulsory, it has been clarified that it will not be mandatory for GPs to charge the co-payment, though they will be left significantly out-of-pocket if they choose to waive the charge.

Under the Government’s arrangements, doctors who decline to charge the co-payment will not be eligible for the Low Gap Incentive created to encourage the imposition of the charge.

In practice, it means that doctors who do not charge the $7 co-payment will be penalised twice – they will incur the $5 cut to their Medicare rebate, and they will forego the partial offset from the Low Gap Incentive.

For a standard consultation, GPs will receive just $31.60, rather than $44.60.

The AMA is concerned that this will hit many GPs as they come under pressure from patients, particularly those less well off, to waive the co-payment on compassionate grounds.

In an attempt to head off the risk that patients try to avoid the co-payment by seeking treatment at public hospitals instead, the Budget measure includes allowing State and Territory governments to impose a charge on people visiting hospital emergency departments with “general practitioner-like” complaints.

The GP co-payment is facing opposition in the Senate. Labor, the Greens and the Palmer United Party have indicated they oppose the measure in its current form, raising the prospect that the Government will have to modify their proposal to secure passage through the Senate.

AMA President Dr Steve Hambleton said the co-payment was an ill-conceived solution to a problem that did not exist.

Dr Hambleton said spending on GP services had virtually stalled in the past five years, while the pathology budget was capped and the Medicare rebate for radiology services had not risen in 10 years.

“This part of the Medicare payment system is not the problem,” Dr Hambleton said.

Instead, the AMA President said, it was providing efficient care, and the Budget changes could lead to greater health expenditure down the track.

“A low income family of sick children will be needing to find multiple co-payments on one day, and higher costs for pharmaceuticals,” he said.

“We already know that individuals defer visits to the doctor and do not have prescriptions filled with small co-payments.

“The very low income earners, the seriously mentally unwell, and the aged will be hardest hit.

“They may not be able to divert to emergency departments because the budget allows for payments to be raised at emergency departments too.”

The AMA said that, nonetheless, there was a place for GP co-payments, as long as they were well designed and backed by a very strong safety net for disadvantaged patients.

One of the criticisms of the Government’s proposal is that the co-payment is charged on the first 10 visits made by concession card patients each year, rather than later visits, deterring them from seeking help at a time when medical care might be of greatest benefit.

There are also concerns that GPs, pathologists and radiologists will come under a great deal of pressure from patients to waive the co-payment and accept a lower Medicare rebate, essentially providing a de facto safety net.

Dr Hambleton said the co-payment also added yet another layer of administrative complexity and red tape for general practice: “Simple bulk billing will now be replaced with a complex system of part payments by patients, which GPs will have to track.”

There is as yet little detail of how the co-payments will be implemented, and there has been no provision made for the extra infrastructure and processes GP practices will need to have in place to track patients and determine when they have reached the co-payment threshold.

To try to soften the blow and make the GP co-payment more politically palatable, the Government has announced that the revenue raised will be directed to help establish and grow the Medical Research Future Fund.

Dr Hambleton said the Fund was “a good thing, but we need both accessibility to primary health care and research – not one at the expense of the other”.

Adrian Rollins