Monday 30 December 2013

Should there be a medicare co-payment required for gp visits?

It appears that the Liberal government in Australia is leaking details of a plan to introduce a 'co-payment' for visits to a doctor that are bulk-billed, in order to find out exactly how much this would upset the electorate, and possibly to also soften voters up before anything concrete is announced in the May budget. The suggested amount is fairly small (about $5) compared to the minimum 'short consultation' fee bulk-billed for a GP visit, but would hopefully curb 'over-servicing' - whereby some elderly or unemployed patients sometimes visit their GP with great frequency in order to have a chat, rather than for any specific medical need.

While the AMA (the doctors 'union') always meets any suggestion of a co-payment with predictions of adverse patient outcomes ('the poorer patients won't see their GP when they need to') such dire predictions have to be taken with a grain of salt, given the conflict of interest between seeing patients as often as needed with the need to see patients as much as possible in order to boost bulk-billing income (one doctor was recently investigated for claiming to have seen hundreds of patients an hour, thereby billing medicare for thousands of dollars. When questioned about how he could treat a patient in less than a minute, he claimed he 'eyeballed' all these patients in his waiting room!). While the vast majority of doctors are presumably highly ethical and wouldn't think of trying to 'rip off' the public health system, it would be easy to tolerate over-servicing as actually providing a medical service - after all, the little old lady on high blood pressure medication that comes in for a chat every week might indeed benefit from such close medical supervision, and, like chicken soup for the 'flu, while it might not be doing any significant good, it can't hurt (except the federal budget).

The Labor party, having been trounced in the recent election, but bouncing back in the opinion polls (now that the new Liberal government has to actually work out which services to cut or taxes to raise in order to have any chance of reducing the multi-billion dollar deficits entrenched while Labor was in government) is obviously keen to portray this a terrible new tax, a hence a 'broken promise' (although if you promise not to raise taxes, not to cut services, AND to reduce the deficit, as both parties seemed to do during the campaign, how can ANY promises be considered 'core'?). The also like to portray a co-payment as the first step in dismantling medicare, claiming that that is part of the Liberals 'hidden agenda'... although since a similar co-payment was suggested by Bob Hawke it seems that both parties occasionally realise that the current rate of rise in health expenditure is unsustainable in the long term.

However, a co-payment probably would discourage some poor people from seeing a GP when they need to. But then again, some pensioners already choose to spend part of their government unemployment or aged pension on booze, cigarettes, and sometimes illicit drugs, rather than on medical care, or even the educational needs of their children (hence the well-intentioned but controversial 'intervention' and 'managed payments' schemes).

Overall, it seems a small co-payment for GP visits would be a good thing, so that the finite health budget can be spent where it is off greatest actual benefit to public health, but would probably also have to be matched by a similar amount of 'out-patient fee' at the public hospitals funded mostly by the states, otherwise there would be a large movement of bulk-billing patients from GPs to public hospitals in order to avoid the fee.

It will be interesting to see how much 'outrage' over this measure actually attracts - in some ways it seems very similar to the mock outrage that was whipped up when a small 'user pays' fee was introduced for all ambulance services - prior to which there were cases reported of elderly patients calling an ambulance to take them to public hospital for free, in order to fill the medical prescriptions, simply to save travelling to the nearest pharmacy by bus or taxi to fill their prescription! Any public service that appears to be entirely 'free' to the consumer will end up suffering from considerable over-servicing, often at huge expense to taxpayers for very little benefit.

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