In 1991 the Hawke government announced the introduction of a Medicare co-payment of $3.50 per GP visit. In an attempt to save face after widespread public backlash, the fee was lowered to $2.50.
The end result? Hawke was ousted as Prime Minister by Keating that same year.
To be fair, that wasn’t the only reason Hawke lost the Labor leadership but it was the beginning of the end for him. You may have heard that recently the Commission of Audit, headed by former Abbott health advisor Terry Barnes, recommended the implementation of a co-payment system for all bulk billing GPs in an effort to reduce the number of ‘unnecessary’ visits to GPs.
The report suggest a $5 or $6 compulsory consultation fee for the first 12 bulk-billed visits to a GP per year per individual, with subsequent appointments bulk billed for ‘free’ as usual. This would end the current system of ‘free’ visits to a GP and would save $750 million dollars over four years.
$5 or $6 isn’t a lot of money, right? So what’s the problem?
There are many problems with introducing a co-payment for Medicare. First and foremost, one of the wonderful things about Australia is that we have a form of universal health care through Medicare which means that everyone has access to health care. The $72 maximum yearly co-payment total may not seem like a lot of money for the average Australian but for some $5 or $6 a week can make or break a budget.
Terry Barnes himself said that it would be “very affordable for most Australian households”. Most, but not all. This completely undermines to purpose of Medicare as one of key principles of the system is universality. This fee would directly affect the most vulnerable groups in our community.
Those who visit purely bulk billing medical centres are usually from low socio-economic backgrounds including students. The number of medical centres which bulk bill all patients and not just pensioners and healthcare card holders is very limited. Many medical centres already have a form of co-payment in effect for most patients called a ‘gap fee’. Given that most students either are not eligible for or simply do not have a Health Care Card means that they do not receive concession fees at medical clinics. A fee would eliminate the limited number of entirely bulk billing clinics which vulnerable groups rely on.
To put this all in perspective, let’s look at an example of a female undergraduate student who lives out of home and is on the contraceptive pill. A 2012 Universities Australia report found that two out of three employed full-time undergraduate students earn under $20,000 a year which is under the poverty line. For those students living out of home it is already a struggle to budget week to week. The price of the pill can range from as little $5 with a Health Care Card to $70-$80 for 3 months. Each time a student needs a new prescription she has to attend a GP to get a blood pressure test and to renew the prescription. A co-payment would be an additional $5 or $6 each visit which adds up.
It must be noted that Medicare isn’t free because Australian tax-payers already pay to see a GP through the Medicare Levy, therefore a co-payment would be an additional fee on top that. There are also concerns that any co-payment opens the door for greater fees in the future as the cost of national health care rises.
The fee’s main purpose would be to eliminate ‘unnecessary’ and multiple GP visits which take up valuable consulting time. Over-servicing is a huge problem but the burden to fix that should not lie with the patient. Increasing efficiency can be achieved by implementing measures such as letting people know results of tests over the phone instead of having to make an appointment.
Both the Australian Medical Association and the architect of the Medicare system, John Deeble, have spoken out against a co-payment system. Deeble has stated that he does not support a co-payment because it would lead to people who should be bulk billed but are not pensioners or concession card holders to not attend a GP. As stated before, this would directly affect students and other vulnerable groups.
A Medicare co-payment policy would not be the ease the strain on the health system, but instead would merely serve as a vehicle to alienate vulnerable groups.