It may just be just a ‘burger and fries’ to some, but according to the Consumers Health Forum (CHF) a $5 GP co-payment can be an unsurmountable burden to people already struggling to afford essential health care.
At a hearing of the Senate Inquiry into the Commission of Audit yesterday, CHF’s Director of Policy, Rebecca Vassarotti, presented the findings of a survey of members undertaken by CHF on co-payments in the health system.
The survey received over 300 responses and revealed that co-payments for health care are already causing significant financial hardship and creating barriers to access for many in the community. Particularly hard hit are people with chronic illnesses, families where more than one member is ill and people in rural and remote areas.
Respondents described how the up-front costs of health care forced them to delay treatment, forgo other essential expenses and choose between health care for themselves or another family member.
Some of the comments included in CHF’s Submission to the Inquiry are below:
“…I live in a rural town and the specialist I needed to see is in Melbourne. I have put it off for over 12 months simply because I couldn’t afford to travel down, a hotel and the specialist fees. I still cannot really afford it, so we are doing a video conferencing appointment, which in my understanding you do not get a rebate. But I would probably benefit more by attending this appointment in person but just cannot afford it.” Consumer from VIC, CHF survey 2014
“I’ve prioritised access to a health practitioner for someone in my family over myself sometimes – if I think their need is greater than mine – this might result in my delaying access for myself – this always requires careful judgement and can be a balancing act.” Consumer from ACT, CHF survey 2014
“I can’t afford as healthy, high quality food and cannot afford social outings.” Consumer from VIC, CHF survey 2014
“We delay using services as the cost is to [sic] great and we can’t afford it financially. Sometimes it means the kids miss out on things that they need but we try to do what we can.” Consumer from WA, CHF survey 2014
“It has had a massive impact on my health due to stress of limited finances and I have needed to move in with my parents as I can not [sic] afford medical expenses and living expenses. It has also impacted my family’s health as they have been stressing about me getting worse without proper treatment/Specialists and about finances as well. I am not able to work due to chronic Illness and I have NO income, I feel that the government does not help enough at all.” Consumer from VIC, CHF survey 2014
“ALL 4 members of our family have chronic health issues, disabilities and need multiple medications. We were all well 9 years ago, when our first daughter was diagnosed with autism and an ID [intellectual disability] – we all started to be diagnosed from then on and none of them seem to be related to each other. As a young family, we are a walking medical dictionary. We require our health care card to ensure that we get all of our medications as cheaply as possible and we need bulk billing are [sic] we are all constantly at the doctor. Before we started to become ill – we were a normal family in high-paying jobs, living the dream life.” Consumer from QLD, CHF survey 2014
CHF’s submission backs up the findings of the survey with international data and economic research demonstrating that co-payments have a disproportionate impact on the sick and poor compared with the healthy and affluent.
This research shows that even small co-payments can create barriers to access for the sickest and poorest in the community. This can reduce the overall equity of a health system and result in higher downstream costs as illnesses become more serious and therefore more expensive to treat. In fact, there is no evidence that the introduction of co-payments results in a more appropriate use of health services or a reduction in total health care costs.
Although subsidies and safety-nets can reduce the inequitable impact of co-payments to some extent, in practice it is very difficult to accurately target those most in need of assistance. This is particularly the case in Australia where there is no accurate national data on the out-of-pocket health care costs faced by individuals and families. The existing Medicare and PBS safety-nets provide little protection for a number of groups in the community facing high health care costs. These include people with chronic conditions whose treatment involves the use of medical devices, non-PBS medicines and allied health services.
CHF has a number of alternative suggestions for policies and mechanisms to increase the efficiency of the health system, for example, through changing the way we fund health care. The Submission recommends a review of Medicare and a move towards a more performance based health care funding framework where rebates reflect the value of the services being provided. These proposals provide the Commission of Audit with a number of more equitable, efficient and sustainable options for managing demand for health care without risking cost blow-outs elsewhere in the system and adversely impacting on the most vulnerable in the community.
Disclaimer: Jennifer Doggett has previously provided consultancy services to the Consumers Health Forum on a number of issues, including co-payments.