Appropriately, the possible end of the government’s bid for a general practice co-payment scheme has been accompanied by confusion and miscommunication.
Is the co-payment, as reported in one backgrounded news report, about to be scraped off as one of those pesky barnacles slowing the progress of the Good Ship Abbott? Or will it, as foreshadowed by Health Minister Peter Dutton today, be implemented via regulation rather than legislation — an outcome so appalling in prospect that Coalition backbenchers have already emerged to warn against it?
We have never had a rational explanation of this policy from the government. On one hand we were told it was designed to address the unsustainability of healthcare spending — but Australian Institute of Health and Welfare data showed growth in national medical expenditure slowing; indeed spending actually fell in 2012-13. On the other we were told it would fund a vast new medical research fund — belying the entire point about unsustainable health spending.
Dutton, a politician never renowned for his profile or powers of communication, has simply never been able to articulate a consistent argument for the co-payment beyond a robotic insistence that health spending was unsustainable.
There is, potentially, an arguable case for a price signal in primary healthcare to minimise over-use, but it raises equity concerns that any well-considered co-payment scheme could have addressed. The mechanism put forward by the government simply failed to do this. This has not merely been a failure of communication on behalf of the Abbott government, but one of substance as well.
I thought that Dutton’s main reason we had to have it was “all Labors’ fault”?
The co-payment was to deter low income people from going to the doctor. Middle and high income people would be able to afford early medical treatment but low income people, particularly the frail aged would wait until the illness had reached intolerable seriousness before they would prioritise the co-payments required for the G.P., the pathologist, specialists, x-rays/imaging, the pharmaceuticals and possibly traveling to distant medical services. It was a vicious ugly policy that the Coalition was unable to explain with any decency or coherence, sometimes claiming it was because of unsustainable and rising health care costs, desperate budget deficit that was all Labor’s fault and at other times saying it was for a medical research fund that would save billions of dollars in the future – throwing expressions like discovering cures for cancer into the conversation. It was just to stop low income people getting early medical care that could be life-saving.
Clearly the co-payment has been a disaster for the Govt.
A sensible co-payment would operate in reverse. Allow 6-8 annual visits to a GP without payment and then a $10-15 charge after that.
Those who use up their visits in a shorter than 12 month period should be flagged for a chronic disease assessment where they would go on a management plan and be exempted from co-payments.
There could be no objection on preventative medicine grounds (missing chronic illness because of a co-payment for the first 10 visits), and a signal that the system is not open ended for the normally healthy who have a head cold or want a certificate for a sickie.
Thank you, Crikey, for finally raising this issue.
Firstly, ANY attempt to introduce a co-payment will immediately defeat the basis for a universal health system. To have one of these, equity and affordability for all must be maintained.
Secondly, such a co-payment may save money in the short term, but will cost MUCH more down the track. Those who can’t afford to go to their GP will eventually have more serious and costly health issues to be dealt with by the health-care system in the medium to long term.
Thirdly, why do people keep saying that Medicare is ‘free’? It is NOT. All taxpayers pay a Medicare Levy, which funds part of the system, and the remainder is topped-up from general revenue (more taxpayers funds – the government doesn’t have any money of its own).
Finally, what is wrong with raising the Medicare Levy? It only needs a small increase to raise billions of dollars. This will sustain a universal halth-care system for the foreseeable future. Historically, this is the way it has always been done. The co-payment policy is an idealogical brain-fa+t from the usual suspects, who couldn’t care less about those on the bottom of the ladder. These are the very people Medicare was designed to include.
Gawd forbid that we should go down the American path, where health-care costs per person are almost double what we have in Oz.
Having worked in the healthcare system for over 45 years, I urge people to think carefully on this issue, before they throw the baby out with the bathwater!
When Tony Shepherd’s National Commission of Audit report introduced the copayment concept back in May he was quite clear that it’s purpose was to function as a disincentive for doctor visits
He told us (incorrectly as it turned out) that we went to the doctor, on average, 11 times a year and this was way too much
Shepherd was immediately slapped down and when it was subsequently included in the budget, it’s purpose was to create a medical research fund that would, inter alia, cure cancer.
Now, according to Dutton, we are back to the ‘price signal’ rationale
Confused? You bet you are, err You bet I am.