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Issue #1660      October 15, 2014

Government still pursuing Medicare co-payment

Last week, the Abbott government tried to blackmail the Labor opposition into supporting its suspended budget items in order to pay for Australia’s participation in the new Middle East war, for which the Labor leadership had blindly offered bipartisan support.

In reality deferred treatment will decrease the patient’s chances of recovery and add to the overall health costs for state governments.

One of those items was the scheme to charge patients Medicare co-payment fees, including a $7 fee for GP visits. To date Labor, the Greens and the Palmer United Party have blocked the scheme, but the government is still keen to push ahead.

NSW Health Department report obtained by the state Labor opposition last week revealed that charging a $6 GP co-payment fee would result in the state’s public hospital emergency departments being flooded with an extra 500,000 patients. It would also cost the state an extra $80 million per annum, and federal health allocations to the states have already been cut.

The report confirmed warnings from three Sydney public hospitals that their emergency departments would be overwhelmed due to the co-payment scheme, and that poor people, children and the elderly would be worst affected.

Australian Medical Association vice-president Brian Owler has warned that the scheme would reverse recent gains made by public hospitals in reducing emergency waiting times.

He commented: “… driven by [the government’s] fiscal and economy outlook there is no consideration of the health care needs of the Australian community”.

NSW Health Minister Jillian Skinner at first denied that her department had carried out any modelling of the effects of the co-payment on emergency services. When the Health Department report became public she accused the state opposition of scaremongering and described the modelling as “rudimentary”.

Federal Health Minister Peter Dutton arrogantly declared the report’s figures had been “cooked up by obvious union sympathisers”. However, the Abbott government has already tacitly admitted the problem by suggesting to the states that they should consider charging emergency patients a fee for GP-type consultations.

The states have not taken up that suggestion but if they did, so many patients would defer consultations and miss out on early diagnosis, thereby raising the risk to their health (and to public health in the case of infectious diseases) and increasing healthcare costs to the states.

Sydney’s Canterbury Hospital has already reported increasing numbers of patients visiting emergency departments, including children suffering asthma, because they can’t afford prescription medications.

Requiring GPs to implement the co-payment scheme would also tempt them to charge above the current Medicare scheduled fee. Doctors who currently bulk bill do so because they believe in a free public health system and/or because it increases efficiency and allows them to see more patients.

But if they have to charge the co-payment anyway, many are likely to begin charging above the scheduled rate and their patients will pay more than the $7 co-payment fee.

Dutton has claimed that: “Commonwealth spending on health is increasing each and every year. If action isn’t taken Medicare will collapse under its own weight.”

That’s nonsense. Federal health spending has risen at an average annual rate of only 5.7 per cent over the last 20 years, while public order and safety has risen by 8.8 percent and communications by a whopping 23.5 percent. The only area in which expenditure has grown at a slower rate than health is science, which has received a shamefully meagre two percent average annual increase.

Rather than collapsing under their own weight, both science and health are suffering from chronic financial malnutrition.

And there are other problems

The government intends to establish the $20 billion Medical Research Future Fund (MRFF), a new organisation funded from $5 out of every $7 Medicare co-payment.

As the Guardian reported last week, the role of the MRFF is likely to be limited to funding medical research by private firms, rather than carrying out research itself, and firms that receive grants are unlikely to have to repay a proportion of the profits derived from successful research.

Healthcare changes proposed by the government are not limited to GP co-payments. Current federal bulk-billing rebates for doctors for complex medical services, including x-rays, magnetic resonance imaging, PET scans and ultrasounds, will be reduced from 95 to 85 percent of the scheduled fee. The patient would pay the extra ten percent as a co-payment.

For Commonwealth health card holders and children under 16 years of age co-payments would be capped at 10 GP visits or specialist services a year. But someone else suffering from, say, liver cancer would be $264 worse off over a year, and might expect to pay a total of $1,200 for scans, consultation and pathology per annum. If the cancer has spread beyond the liver the extra cost would be $678, and the total cost would rise to $2,200.

Many patients would certainly defer treatment if confronted with costs like that. Indeed, the Abbott government intends the co-payment scheme to reduce the number of GP visits, thereby reducing Medicare bulk billing and saving the federal government an estimated $3.6 billion.

But in reality deferred treatment will decrease the patient’s chances of recovery and add to the overall health costs for state governments.

Dutton has claimed that the Abbott government intends to make Medicare “sustainable”. But if the co-payment scheme gets past the Senate, even with a reduced co-payment, Medicare as a free public health system will disappear.

The co-payment scheme has been momentarily shelved, but certainly not abandoned. Despite its unpopularity, the Abbott government is still determined to put it into practice.

The government’s unshakeable commitment is to big business, not to ordinary working people, and in the case of public health they are determined to promote the interests of the private health insurance companies and private medical research firms.

One Fairfax editorial noted: “It is easy to see the GP co-payment as less a budget savings measure than an ideological ambit claim intended to soften the ground for more user pays in health. Already Medicare Private and others are seeking preferred deals for insured patients in a step towards entrenching a two-tiered US-style system.”

And that’s a move we should defeat at all costs.

Next article – Protest at ABC board meeting

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