The outcry of the planned introduction of $7 fee for visiting a GP underlines the sensitivity that the public has around co-payments. It will be very difficult for general practices not to charge the fee given that Medicare rebates for attendance items will be cut by $5. Apparently this attempt to strengthen general practice can be done with an extra $2. Many people, especially doctors, think that health financing has got something to do with paying for quality patient care and improved patient outcomes. It hasn’t. Health financing is about hard politics.
When the co-payment proposal reached Cabinet you suspect that a large part of calculations were not just on fiscal deficits but also in terms of its electoral effects. Agreeing to any co-payment was the equivalent of jumping off the chair. It will make health THE issue at the next election in a way that risks a one-term government. All the arguments about everyone contributing something to help the country reduce the deficit will be long forgotten at the next election. But every time a voter in a marginal electorate pays the $7 at the GP surgery it will have an impact on the local MP’s future job prospects. And the thing is that these same voters in a marginal electorates will be making such payments at least 10 – 20 times before they head to the ballot box.
Politicians seem to have short memories. Arguably Paul Keating became Prime Minister after Bob Hawke agreed to a Medicare co-payment, a copayment that was hastily abandoned. And John Howard became Prime Minister when he gave up on the idea that Medicare was not middle class welfare.
Healthcare matters and it makes voters change their votes. Hopefully Tony Abbott and Peter Dutton have an alternative better healthcare system to present at the next election. But no party has produced such a policy since Medicare started.The current proposal’s marginal, economic benefits alone will not be sufficient to convince swinging voters that they will benefit for paying for a service that that they have been trained to believe that they have a “right” to access for free. Australians already pay some of the highest co-payments in the world yet this does not seem to have altered the increasing demand for healthcare services. Placing another ineffective price signal will not decrease demand, the apparent aim of the policy, but simply redistribute it.
The practical consequences of this, which is already happening, is that patients will use A&E services — which are free to the voter but significantly less efficient. The states are likely to charge much more than $7 for a visit to the hospital as they really want to discourage patients from presenting to their very expensive, often debt-ridden, hospitals.The pictures of untreated children standing at the front of children’s hospitals will not enhance the political appeal of the policy. Furthermore, every voter will be paying for a visit to the hospital.
Rather than trying to limit the supply of primary care services, the government, like many governments around the world, should be increasing funding into primary healthcare. The future of healthcare is not in the tertiary sector but the delivery of low-cost care near each and every patient’s home.
The introduction of a $7 gap is a simplistic attempt to demand manage a public good which has never complied to the basic economic laws of demand and supply.
In political terms, this will be a Sir Humphry Appleby “brave decision”.
The opposition can start commissioning their advertisements for the next election.
Source: Facebook