Other ways … the government can save billions from health spending without introducing a GP fee. Picture: Thinkstock
PRIME Minister Tony Abbott said this week he “should have known better” than to try and introduce a $7 fee to see the doctor, and he was right.
A quick tour of Australia’s political history shows politicians who try to make people pay to see a doctor put their survival at risk.
In 1991 Bob Hawke’s attempt to introduce a $3.50 Medicare copayment became the focus of Paul Keating’s successful campaign to depose him.
In 2004 John Howard came under pressure when the GP bulk billing rate plunged to 67.6 per cent (it’s 82 per cent today).
GP FEE: Dead, buried and cremated
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Going going gone … PM Tony Abbott dumped his unpopular GP fee this week and said he should have known better than to try to introduce it. Picture: Ray StrangeSource:News Corp Australia
His health minister Tony Abbott solved the problem by increasing the Medicare rebate by $5 and introduced extra payments to encourage doctors to bulk bill children and concession card holders.
Despite having this experience under his belt Tony Abbott still pushed ahead with a plan for a GP copayment that would end bulk billing for many in his 2014 budget.
His standing in the polls has plunged and he’s been forced into three back downs on that policy but he still can’t give it up.
Even though the $5 GP copayment was this week declared “dead, buried and cremated” Health Minister Sussan Ley is still looking at changes that would allow doctors to introduce their own copayments.
Making progress … Health Minister Sussan Ley announced the axing of the GP copayment. Picture: Gary RamageSource:News Corp Australia
While there is some merit in the argument that wealthy people should not be able to see a doctor for free it’s worth remembering these wealthy people already pay higher taxes for health through the Medicare levy.
And that one in five GP visits currently do attract a copayment of up to $50.
Experts argue introducing a financial barrier to seeing a doctor will see some people delay seeking help until their problem is so bad they are hospitalised or increase pressure on busy emergency departments.
A GP visit costs taxpayers just $37 but a visit to an ED visit costs $290 and a hospital inpatient bed up to $900 a day.
Mr Abbott correctly observed this week that “it is not possible to do optimal health reform in this country without the full backing and support of the medical profession”.
The latest copayment he’s considering will have the support of the medical profession because it will allow them to boost their incomes, the previous copayment proposals would have cut their incomes.
New alternative … Associate Professor Brian Owler, President of the Australian Medical Association is likely to support a plan to allow doctors to charge their own copayments. Picture: Kym SmithSource:News Corp Australia
The government says we need a GP copayment because Government expenditure on Medicare has more than doubled from about $8 billion to $20 billion over the past decade.
Former Health Department secretary and Grattan Institute researcher Stephen Duckett says these numbers fail to take account of inflation or population growth.
“What looks like more of a doubling from $8 billion to $20 billion is in fact an increase of only 20 per cent when it’s adjusted for the consumer price index rises (inflation) and population growth,” he says.
Federal health spending actually fell by $70 million or 2.4 per cent in 2012-13.
And the growth in total health spending in 2012-13 was at its lowest level in 30 years the Australian Institute of Health and Welfare reports.
Opposition health spokeswoman Catherine King says the government’s claims the Medicare levy doesn’t cover the cost of the scheme are spurious.
“ Medicare Levy was never designed to cover the full costs of Medicare. It was designed to cover only the additional cost of universal health care — extending Medicare benefits to all Australians.”
“In 1984 it covered just under half the cost of Medicare, today it covers more than half,” she says.
Too stretched … the Medicare levy was never designed to cover the full cost of Medicare and covers more now than when it was introduced. Picture: ThinkstockSource:News Limited
While the crisis in health funding is not as great as the government has made out it has still lost $2 billion in budget savings as a result of its back downs on the GP fee.
As ministers meet to prepare this year’s May budget experts suggest the government could make even bigger savings by tackling real waste in the health system.
Former Health Department chief Professor Stephen Duckett says a quick fix that would save the government up to $1 billion is to double to 30 per cent the price drop when subsidised medicines come off patent.
Melbourne University health economist Philip Clarke says taxpayers are still paying ten times more than the UK and US for generic medicines.
“We could save at least $500 million a year if we benchmarked prices with those countries on the top 20 biggest selling drugs,” says Professor Clarke.
Quick fix … Doctor Philip Clarke, professor of health economics with the University of Melbourne’s Centre for Health Policy, Programs and Economics. Picture: News Corp AustraliaSource:News Corp Australia
Other experts have identified 150 low value services we pay for under Medicare that could be scaled back.
We could save around $500 million a year of we acted on just 26 of these says Associate Associate Professor Adam Elshaug from the Menzies Centre for Health Policy.
For example of vitamin D tests leapt from 90,000 a year in 2003 to 4.3 million in 2013.
We went from spending $3 million in 2003 to $145 million in 2013, on a single blood test, Elshaug says.
New restrictions on these tests are already saving tens of millions of dollars.
We’re saving $50 million a year by splitting Folate and Vitamin B12 testing.
Elshaug is heading a research project to measure savings from reducing other low value health services as part of the Choose Wisely campaign backed by doctors.
Worth a lok … there are potentially $1 billion a year worth of savings from efficiences in the nation’s drug subsidy scheme. Picture: ThinkstockSource:ThinkStock
The Grattan Institute has found the difference in the cost of a common gall bladder treatment varies by around $4,000, in different hospitals and hip replacements by more than $16,000.
Taxpayers could save almost $1 billion a year if all hospitals met the average cost of treating patients.
Another $430 million a year could be saved if we used cheaper nurses or physician assistants to do some of the work of doctors, the institute found.
Booting paracetamol off the PBS could save $9.6 million a year.
It costs taxpayers $8.66 a pack when we subsidise paracetamol on the PBS when you pay buy the same packs of 100 for $1.89 in discount chemists despite this 1.2 million scripts for Panadol are dispensed a year.
We’re paying $14.48 to subsidise Selsun anti-dandruff shampoo for veterans when a bottle twice the size costs just $4.99 at a discount chemist.
Taxpayers spent $11,408 on this product last financial year.
These are evidence based savings that improve health care and bureaucrats would do well to explore them.