In a consultation with a doctor the opinion of the patient is primary, so the doctor’s political beliefs shouldn’t play a part. Therefore, as I see my social media presence as an extension of my consultation room, I have tried to keep political comments away from my Facebook page. I have decided to break that rule because the healthcare debate in Australia today has far reaching consequences. It has hit the headlines as the $7 copayment for GP visits that is proposed to start in July 2015. But it is about more than that: it is about the future structure and culture of healthcare in Australia.
Below I have listed some of the issues and consequences of the proposal as it currently stands.
–Plenty of people don’t have $7 to visit the doctor. A user pay system implies everyone has the same access to $7. This is not true. Adolescents needing confidential information, people (mostly women) with non paying care duties, the elderly and the chronically sick will all be disproportionately affected.
–Many consultations are bulk-billed at Hampton Bayside. We are able to do this because we charge more for the big stuff (normal consultations) and can bulk bill people in particular financial difficulty and also the smaller stuff like flu vaccines, nurse-led vaccine clinics, quick consultations, etc.
–The fee supplied by the government for every normal consultation will go down by $5, so out of pocket expenses are likely to increase across the board, not just for the consultations currently bulk-billed.
–Although GPs will be able to waive the copayment and let patients have no fee, the fee received by the GP for consultations with children and people with pension or healthcare cards would decrease by more than 25% for a regular consultation and more than 50% for a short consultation (such as a quick referral or flu vaccine).
–For that reason, free-at-point-of-care healthcare in Australian general practice would cease.
–Every consultation, every quick follow-up and every vaccination would all incur a $7 fee.
–Vaccination rates will decline; herd immunity will decrease.
–Because of the copayment on pathology and xray I would order less tests. Things like taking a swab to see if someone has influenza, not an earth-shattering question but interesting and important nevertheless, would be less likely to be done. To continue the flu-swab example, not doing swabs will miss less common presentations of tonsillitis or unusual skin infections: conditions that need specific treatment.
–With a payment incurred in Emergency Departments, people will be less likely to seek help for things they consider urgent. Some will be genuinely medically urgent; all will have failed my central gauge of importance, the sleep rule.
The changes, if enacted as currently proposed, would move Australia much closer to an American style health system. It will be a less compassionate and less efficient system. The inequity already present will increase dramatically, vaccination rates will drop and people will seek medical care later when they are sicker and thus be more likely to need expensive admissions to hospital rather than home-based care, so I don’t even think it will save money.
I am, as I am sure you can tell, very concerned about the proposals. They will affect all patients and all GPs, but will disproportionately affect patients with less ability to pay and those who need to see the doctor more. I am worried that the culture of Australian healthcare will change, and we will all be worse for it.
Source: Facebook