How the GP co-payment can be saved By Terry Barnes Thu 14 Aug 2014, 1:45pm After years of debate and negotiations Howard and Costello got their GST, and the sky didnt fall in. With sensible adjustments the same will be said of GP co-payments, writes Terry Barnes. The budgets $7 co-payment on bulk-billed GP and related pathology and radiology services is the health care equivalent of John Howard and Peter Costellos campaign to introduce the Goods and Services Tax a decade and a half ago. Similar to the GST, the co-payment challenges long-established assumptions on the fundamental principles of Australias healthcare system and particularly its central institution, Medicare. Different to Howards great tax adventure, however, Prime Minister Tony Abbotts Government faces the trenchant parliamentary opposition of Labor and the Greens, powerful vested interests like the Australian Medical Association and, above all, is challenging the Australian publics love affair with Medicare itself. While not everyone is bulk-billed, most Australians clearly believe that fairness demands that those who are poor and vulnerable are. Because the budget measure was engineered to extract maximum savings ahead of structural reform, it differs markedly from the Australian Centre for Health Researchs GP services-only plan that had been debated for months before budget night and has not been sold particularly well by the Government. Needing crucial Senate crossbench support, especially that of PUP kennel-master Clive Palmer, what currently is on the table will not pass. To their credit, Abbott, Health Minister Peter Dutton and Treasurer Joe Hockey are now open to reaching a co-payment settlement at least palatable to the Senate and vested health care interests while preserving the basic principle. Indeed, it is considering a plan submitted by the AMA to Dutton last week on how to do just that. Despite its significance, however, the AMAs plan has not been made public. Unlike the ACHRs original co-payment proposal and the Governments budget measure, both of which were sliced and diced every which way by the AMA and other opinion leaders, the doctors trade unions proposal is being hidden from public scrutiny and, it seems, no other party has been similarly invited to put forward solutions to the Government. This, frankly, is wrong. Can the co-payment be repaired? Even a watered-down co-payment would compromise our health system, writes Stephen Duckett. The AMAs secret ideas aside, practical suggestions can be made on how to save the co-payment from political oblivion. Some relate to content, some to fairness, and others to its selling. First, content. The co-payment should be reduced to $5, and the planned $5 cut to related Medicare rebates should go. The AMA and GP groups would be delighted at the latter, and the former makes political sense as being way lower than the Commission of Audits $15, lower than the current $7 and even lower than the ACHRs proposed $6 co-payment. It would also be easier to administer, the patient simply passing a fiver to the GPs receptionist. No Medicare paperwork, no fuss. Coupled with that, only bulk-billed GP services should be covered. As Stephen Duckett has pointed out in his latest article for The Drum, GP visits invariably attract referrals for pathology tests and diagnostic radiology. Then the patients results go back to the GP for further consultation. This can mean, for even relatively simple complaints, cascading co-payments. If a middle or lower-income person or family doesnt have access to a co-payment safety net that can be a big financial hit and provides a far harsher price signal than what the original co-payment proposal envisaged. Second, fairness. Cascading would quickly eat away at the $70, 10 service co-payment ceiling in the Governments plan. But with a $5 co-payment on bulk-billed GP services only, the ceiling could be set at 12 services ($60) a year. Given that the average number of GP services per person per year is about six, relatively few people would reach this ceiling, but for fairness it is still required. Pensioners and concession cardholders should not be exempt, however, as the AMA apparently is suggesting. Instead, their safety net should be a one-off increase of $60 to pensions and other income support (including Family Tax Benefits in the case of families with young children), compensating eligible Australians for 12 co-paid services per year - even if they dont use that many. Going down that path ensures fairness to the most vulnerable, but also would be cleaner and simpler to administer by GP practices and Medicare authorities. Furthermore, all bulk-billed GP services should attract the $60 ceiling, whether or not a person is a pensioner or cardholder. Until we have several years of real time experience, it is far better, and fairer, to apply the test to all bulk-billed patients. If, as now, doctors want to decline bulk-billing to those who have the means to contribute, they should also be encouraged to do so. Dutton is right: both sides of politics have for too long obsessed over boosting bulk-billing rates for free services ahead of the most efficient use of scarce public resources. Reserve bulk-billing for the most vulnerable. Lastly, selling the supposedly unsellable. The Government may have struggled so far, but it can rule a line and, in the words of former treasurer Peter Costello, reboot its co-payment sales pitch. Costello spoke particular sense when he suggested the Governments next Intergenerational Report be brought forward to make the case for measures keeping Medicare and our health services sustainable into mid-century and beyond. What has been missing from the Governments armoury is a strong, evidence-backed narrative that makes a sober and systematic case for the GP co-payment and other tough health savings measures that the Australian public is reluctant to swallow. Indeed, the Government should go further than Costello suggests and, by the end of the year, release its own White Paper or similar policy blueprint setting out a coherent, practical and implementable Coalition strategic health policy vision. If voters know the Government itself knows where its going, they will be more assured that the specific tough medicine they are being given has higher purpose and meaning. To be sure, refinements including those proposed here mean a significant short to medium-term haircut for the Governments projected budget savings. But the intended price signal and demand effects would remain and, combined with other reforms to hospital funding, private health insurance and the Pharmaceutical Benefits Scheme, the co-payment package would far more effectively contribute to long-term structural reform of Medicare that would balance fairness with real efficiency dividends in the future. After several years of fierce and anguished debate, negotiations and a willingness to compromise strategically, Howard and Costello got their GST, and the sky didnt fall in. With sensible adjustments, the same will be said of co-payments on bulk-billed GP services. Terry Barnes wrote the Australian Centre for Health Researchs proposal for a $6 co-payment on bulk-billed GP services released late last year. He was also a senior advisor for then health minister Tony Abbott during the Howard government. Follow him on Twitter @TerryBarnes5. View his full profile here. abc.net.au/news/2014-08-14/barnes-how-the-gp-co-payment-can-be-saved/5669728
Posted on: Sat, 16 Aug 2014 14:31:35 +0000
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