Health and medical groups say they have serious concerns about impact of proposed Medicare co-payment
Australian patients, particularly seniors and disadvantaged groups, are already struggling to meet out-of-pocket health costs and could further be discouraged from seeking necessary care as a result of the government’s planned new co-payments, a parliamentary inquiry has heard.
Health and medical groups, seniors representatives and consumer advocates told the Senate’s community affairs references committee on Tuesday they held serious concerns about the impact of the budget decisions, including a $7 fee for visits to GPs and out-of-hospital pathology and diagnostic imaging services from July next year.
The government also wants to increase the existing co-payments for pharmaceutical benefits scheme (PBS) medicines in January next year, but both measures are likely to be defeated in the Senate.
The Australian Medical Association (AMA) is close to presenting an alternative plan to the health minister, Peter Dutton.
The Council on the Ageing (Cota) revealed it had fielded “a flood” of post-budget calls from seniors who thought the Medicare co-payment was coming into force immediately and who were planning to stop going to the doctor.
At a committee hearing in Canberra to consider out-of-pocket costs in Australian healthcare, the Consumers Health Forum predicted people would face difficult choices about whether to prioritise medical visits, treatments, food, heating and other spending, which potentially could have long-term serious health consequences.
Department of Health officials confirmed they did not have details about the potential impact of the measures on particular groups or the effect on individual practices, but repeated their estimate that the Medicare co-payment would reduce growth in overall GP visits by one percentage point in the first year.
The department’s acting deputy secretary, Richard Bartlett, said GP visits would continue to grow, but by 3.5% rather than 4.5% in absence of changes – a difference of about one million visits.
Asked whether there was any indication people with serious illnesses would avoid medical care, Bartlett said: “Logically you would expect that if somebody is feeling particularly ill, they’re more likely to go and see a GP than somebody who’s not.”
The Greens senator Richard Di Natale said symptoms did not necessarily correlate with severity of potential conditions. Bartlett replied: “They may or may not.”
Bartlett argued the 10-service annual cap on co-payments for concession card holders, and the ability of GPs to decide not to charge the co-payment on a case by case basis, were designed to ensure people on lower incomes were not discouraged from consultations.
The government’s plan involves a $5 reduction in the Medicare benefits schedule (MBS) rebate for standard GP consultations and out-of-hospital pathology and diagnostic imaging services, with providers then allowed to collect a patient contribution of $7 per service. The practical effect of this is that the GP receives $2 of the $7 effective co-payment – a move the government argues provides flexibility for doctors to exercise discretion.
But the national policy manager for Cota Australia, Jo Root, told the committee older people had the “triple whammy” of vulnerability because they were older and often had low incomes and chronic diseases.
“There was a lot of media speculation on MBS and PBS co-payments and we started to get a steady stream of people contacting us with concerns about what this would mean for them, how they were going to pay for them and on the quality of their life,” she said.
“When the budget was brought down that stream turned into a flood, it has to be said, with a lot of people contacting us thinking first of all that the Medicare co-payment, the GP co-payment, was going to come in straight away and thinking they should stop going to see their doctor now, and they did raise the issue about having to make choices about whether they would go to the doctor, whether they would get their script filled.”
The chief executive of the Consumers Health Forum, Adam Stankevicius, said there was “significant concern” among healthcare consumers and the broader community “about ever-rising out-of-pocket costs in healthcare”.
“ABS data from 2012 tells us that 9% of adults will delay or not collect medical prescriptions due to cost and our own national survey supports this finding, with fully two-thirds of respondents to our survey indicating that they had at some point delayed seeing a medical practitioner – nearly half of them citing cost as a contributory factor,” he said.
Stankevicius pointed to a report in June by the now-defunct Council of Australian Governments Reform Council which showed people in the most disadvantaged areas were twice as likely to delay or avoid filing a medical prescription because of cost, compared with the most advantaged areas.
“This dangerous trend of delayed visits to medical practitioners, unfilled prescriptions and unbooked diagnostic referrals not only leads to a deficit in appropriate treatment but will also lead to a higher likelihood of a health system which will have to bear the increased costs of a higher rate of hospital admissions and emergency department visits,” he said.
“Studies have shown that following the January 2005 increase in PBS co-payments, there was a significant decrease in dispensing volumes observed across 12 of the 17 medicine categories including anti-epileptic medication, anti-Parkinson’s treatments, combination asthma medicines, insulin and osteoporosis treatments.”
Marie Skinner, senior policy adviser of National Seniors Australia, said a survey of members taken before the government’s decisions showed some support for a form of GP co-payment, but this did not extend to other referral services and extra PBS costs.
Stephen Duckett, director of the health program at the Grattan Institute, said the share of health spending paid directly by Australian patients was “unusually high in international terms” and increasing out-of-pocket costs further was “the wrong way to save money”.
“The more so-called necessary services reduced alongside unnecessary ones the worse the outcome,” Duckett said. “There could be health consequences and increased long-run costs.”
The AMA president, Brian Owler, is expected to meet with Dutton on Thursday to discuss progress on the AMA’s compromise proposal, which is likely to include significant carve-outs to protect disadvantaged groups and deliver far less than the $3.5bn over five years the government had budgeted.
Owler said he opposed any reduction in the MBS rebate and linking the co-payment to the proposed new medical research future fund. These changes would represent a significant departure from the government’s stated policy.