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Proposal for Copayment for hospital ED wont work and confirms that there is serious concern about GP copayments acting as a disincetive to GP visits

The DRS today called on Health Minister Peter Dutton to rule out changes to Medicare including copayments for GP visits and charges for attending the ED department.  This is getting sillier and sillier said DRS spokesperson Dr Con Costa.  First they say they will introduce a charge to see the family GP, and that it is only a small charge that won’t dissuade people from seeing a GP.  Next they are saying that charges should be introduced to state public hospitals to prevent an influx of GP patients who can’t afford to pay the copayment.  Which one is it?

 The report by Terry Barnes, former health adviser to PM Mr Abbott includes – “We think that $5 or $6 would not be enough to deter people from going to the doctors if they absolutely need to,” he said.

“We’re saying this is quite reasonable to keep the whole system going.

This is sending a price signal to people, there’s no doubt about that… the level of co-payment we’re suggesting is equivalent to a hamburger and fries or a schooner of beer, it’s not a great deal.”

Mr Barnes further promotes the idea of a similar charge to stop people from going instead to the ED departments of their local public hospital. 

Health Minister Peter Dutton has not ruled out a fee for patients visiting their doctors, saying in a statement the Government “won’t be commenting on speculation around what the Commission of Audit may or may not recommend”.

This is truly the silly season said Dr Costa. 
Proponents of the GP copayment are admitting that such a copayment would be a disincentive for people seeing their family GP and lead to a run on hospital ED’s as people seek to avoid the copayment.   This alone would be a strong argument against a copayment ie it would be a disincentive for people attending a regular GP early in an illness or for routine preventive screening.  – and our public hospitals are  already overcrowded with more serious type emergency cases.  The last thing the ED doctors need is an influx of refugee patients from GPs. Secondly the introduction of a copayment for the GP is cost shifting from federal to state government budgets – and so the states are being encouraged into  a tit for tat retaliation ie the states who would be forced to introduce charges in the emergency departments of public hospitals – thus making it difficult for people to access emergency care. It is not just a question of attempted cost shifting by the federal government. Our hospital EDs cannot take over the role of the family GP.  ED cannot provide immunisation or preventive women’s health checks or monitor diabetes or high blood pressure patients.  There would be no continuity and no cumulative memory if people are driven to seek their routine medical care in the hospital ED.  It would also be a very expensive and inefficient way to run a health system, said Dr Costa. There is only one fair and realistic way to save money in the health system said Dr Con Costa.  We must provide community based care based on early prevention and good management of chronic or advanced illness – in the community where it is more appropriately managed and at much lower cost than hospital care.  We have a broken system where most GPs are seeing patients only in their surgeries yet those with complex illness in the community – the elderly in nursing homes, the dying who are in desperate need of palliative care or those who are too sick to get to the doctors office, are simply going without care or end up yo yo ing back and forth to the public hospital EDs in an ambulance.

It is a crazy and heartless statement to portray these patients as needing a price signal to deter them from seeing their GP too often.  These patients often do not have a GP or a so seriously under serviced that they have no alternative but to call an ambulance and sometimes on a weekly basis.  Why blame the patients when the problem could so easily be fixed with better community based care instead of more expensive hospital based involvement.

We now seem to have a federal government which feels that the simple solution is to make everyone pay for their medical care individually ie not through national health insurance/ Medicare. Eroding bulk billing with up front charges/ copayments forces our patients into rear guard measures including avoiding going to the doctor or seeking community based care – until late in the illness when it is much harder to treat.  Instead they present inappropriately to the ED department or simply call an ambulance at great cost to the system – and will create a bureaucratic nightmare for doctors who have to collect the fees as well as encouraging doctors to stop bulk billing.  Encouraging a user pays system will make all of those in residential aged care or needing care in the home, worse off.  A GP copayment would hit mainly women who are often the principal carers as well as women again missing out on preventive health checks – especially women in outer suburban areas. Eroding bulk billing will worsen access to timely and cheap GP care and will further aggravate a situation where many Australians find it difficult to access a family GP and are forced to use the public hospitals for routine medical care.  Charging at the hospital ED is impractical.  Our EDs will end up choked with more patients and the public hospital administration burdened with a bureaucratic nightmare of debt collection.  What is next in the silly season – means testing of public hospitals? asked Dr Costa.

Dr Con Costa   Dr Tim Woodruff

President   Vice President 

0418400309  or (02) 97978710   Ph 0401042619

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