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Health minister 'let down' by colleagues on co-payment sell

27 May, 2014

The proposed GP co-payment scheme is a practical measure necessary for the long-term sustainability of Medicare however Health Minister Peter Dutton has been "let down" by colleagues who have not sold it persuasively, according to a Howard government policy adviser.

"There has been too much emphasis on budget savings rather than structural reform of Medicare," Terry Barnes told The Australian (27 May).

"The co-payment principles should be defended because a price signal is needed to keep Medicare sustainable. But it needs to be seen as fair, modest and reasonable.

"Unfortunately, there are elements of the current proposal that need more work.

"The way the co-payment is currently designed is difficult to sell to voters. It is up to the government to explain how it will work and how it will benefit Australians.

"I think the co-payment should only apply to standard GP services. The government could accept modification while not compromising on the basic co-payment principle."

Being prepared

Barnes said the government should have been "tilling the ground" for the GP co-payment proposal months in advance of the federal budget, however in response to opposition from key health lobby groups now has to play catch up.

"The opponents have been running hard on this since it first became an issue last year. The AMA and the Doctors' Reform Society have been running a scare campaign on this and the government only joined that debate in a real way on budget night.

"Peter Dutton deserves credit for the way he has explained the case for co-payments.

"Unfortunately, he has been let down by his colleagues."

Appropriate balance

Dutton, in an interview in Canberra on Monday (26 May), said a health care system where "everything is given to everybody for free" was neither a practical nor a beneficial approach, and asserted the government had struck an appropriate balance with the co-payment figure.

"If you want to have a Medicare system going forward you have to have it growing sustainably and we have put in place a measure which means that people on higher incomes can pay the $7 so that we can continue to bulk bill for those people on lower incomes," he said.

"The days of hundred per cent bulk billing are over and you cannot bulk bill every person who comes through the door. That was never the intention of bulk billing; it was always about trying to provide assistance to those most in need.

"That's the principle we provide in this package and we believe it should be supported in its current form."

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owen crombie | Thursday, May 29, 2014, 11:24 AM
why not just impose the copayment on smokers, after all if you can pay $20 a pack to get sick, $7.00 a visit to be cured should be no problem!!
John Stafford | Thursday, May 29, 2014, 11:25 AM
Whichever way you look at it this co-payment plan does not stack up. Medicare is seriously in need of a new approach. Dare I suggest we should be looking at the 32% of the burden of health that is preventable through Improvements to our lifestyles. This is a massive burden on our economy and one that could be tackled more readily by multidisciplinary practice teams working to achieve wellness targets (like smoking and obesity levels) and having publicly reportable health outcome indicators. Unleashing the potential of expanded general practices to tackle our major lifestyle/health would do far more to improve health outcomes, productivity, and the economy far more than this unfair copayments proposal.
C M Sexton | Thursday, May 29, 2014, 1:31 PM
Purpose of the co-payment is to get rid of bulk billing practices by increasing their overheads, both by introducing the handling of money with resulting administration and security costs, and time taken with distressed families. Money up front will very often not be $7, more like $43 and up.
Denis Lennox | Thursday, May 29, 2014, 5:36 PM
Unfortunately the proposal that "a price signal is needed to keep Medicare sustainable" is not based upon evidence of the operation of the medical service market. No amount of "selling" overcomes this basis flaw. It perhaps better explains Peter Dutton's challenge rather than his colleagues' lack of appropriate support.
John Stafford | Friday, May 30, 2014, 8:23 AM
Hi Owen. I agree with your sentiments but putting a co-payment on smokers might be hard to implement. After all does a GP have to rely on self -reporting on smoking to charge more? It won't happen or be applied fairly.However a copayment on those who are overweight/obese can be simply measured and applied. This would give a clear signal to (ab)users their weight is a health problem and an economic problem because of their higher utilisation of health services. A refinement might be to give a half rate to those who have undertaken a weight loss program and continue to lose weight. A strong, health message and creates an incentive to live healthily. Along with this could be the requirement for practices to provide weight data to collect MBS payments and the public availability of practice-wide BMI so patients could actively seek out practices that could help improve their health and focus practices on achieving healthy weights for their patients