If the co-payment is scrapped, what next for health funding?

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Analysis by medical reporter Sophie Scott

The freeze on Medicare rebates is likely to stay in some form, while it is looking increasingly likely that the controversial $5 Medicare GP co-payment will be scrapped.

Medical sources have told the ABC the Federal Government was in contact with senior health figures over the weekend about changes to the rebate and the co-payment.

But they said the Government was remaining tight-lipped about what was on or off the table.

Federal Cabinet meets tonight so any proposals could be signed off then, before the joint party room meeting tomorrow.

The Government plans to freeze Medicare rebates for four years, which would lead to a substantial drop in pay for GPs.

Australian Greens health spokesperson and former GP Dr Richard Di Natale said that meant the fight to protect Medicare was not over.

“We will all celebrate if the $5 cut to Medicare rebates is finally sent to the graveyard of dumb policy ideas but nobody should forget that the worst aspect of the Government’s Medicare changes remains in place,” Senator Di Natale said.

Medical sources said it was possible that four years of rebate indexation could be reduced, possibly, down to two years.

From ‘co-payment’ to ‘price signal’

Since Health Minister Sussan Ley took over from Peter Dutton, the language around charging patients more to see a doctor has softened, from co-payment to terms like price signal or value signal.

She met with doctors, patients and public health groups in what was seen as a more consultative approach than her predecessor.

Also new to the discussion was the idea that any contribution would be levied based on income, an idea previously dismissed by Mr Dutton as unworkable.

“We remain committed to a value signal in health where there is a patient contribution that relates to the patient’s ability to pay,” Ms Ley said previously.

But health experts said asking people to pay more for healthcare inevitably leads to some people putting off seeking medical treatment.

Policy expert Dr Anne Marie Boxall said while there were safety nets built in to ensure cost did not prevent people on lower incomes from accessing necessary health care, there was mounting evidence to suggest that they were not completely effective.

Dr Boxall’s paper titled What are we doing to ensure the sustainability of the health system? made several findings.

“An Australian Bureau of Statistics (ABS) survey in 2009 on patients’ experiences of health care found that a substantial number of people were deferring or forgoing treatment because of the cost,” the paper said.

“The survey found that in the previous year, concerns about the cost of care meant that:

  • 1 in 16 people delayed or sacrificed treatment from a GP
  • 1 in 11 people delayed or did not fill a prescription
  • 1 in 10 people delayed or sacrificed treatment from a specialist.”

If co-payment is killed off, what measures are being considered?

Health groups have been aiming to broaden the discussion, from focussing on primary care like GP services to the more expensive end of health care, namely hospitals.

Stephen Duckett from the Grattan Institute said the Government could save billions of dollars by reducing inefficiencies in public hospitals as well as reviewing how the Government pays for medicines.

Other experts have suggested the Government look at removing subsidies for expensive and outdated items on the Medicare Benefits Schedule.

The Government said it would not introduce major changes to health spending without consulting with doctors groups such as the Australian Medical Association.

Doctors, patients and health groups are awaiting the Government’s next move with interest.