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GP co-payments and over servicing, what does the evidence tell us?

As we approach the federal budget, talk of a GP co-payment to discourage ‘unnecessary’ visits is still alive and well despite a range of concerns including those articulated by the AMA and the Consumers Health Forum.

In this article from the Parliamentary Library, Amanda Biggs explores what is known and unknown about factors impacting GP visits and whether evidence exists that consumer driven over servicing is, in fact, an issue.

 

Amanda writes:

One argument forwarded in support of the recent proposal to impose a co-payment for GP visits is that it has the potential to reduce ‘over servicing’, and therefore overall health costs. Over servicing occurs where an unnecessary medical intervention is provided.

Imposing a consumer co-payment on the cost of visiting a doctor will encourage patients to avoid unnecessary visits, thus reducing over servicing and saving the health system money, argue advocates of co-payments. But what is the evidence that over servicing is a problem or that it is being driven by unnecessary consumer demand?

Before proceeding, a distinction should be made between the extent of over servicing and the incidence of the illegitimate practice of ‘doctor shopping’.

‘Doctor shopping’ typically occurs where a consumer engages with multiple health practitioners in an effort to illegitimately obtain a medical service such as a prescription opioid, often misrepresenting their condition to the doctor. Doctor shopping is most commonly associated with drug addicts, so it is arguable whether a co-payment would deter their behaviour.

Because of concerns around doctor shopping for illicit drugs, measures have been implemented in recent years to address the problem, including the Prescription Shopping Program and electronic recording of dispensing of certain prescription drugs. While mostly associated with drug addicts, there is also some evidence to suggest that doctor shopping can occur among legitimate patients who are simply seeking a cheaper service in areas where bulk billing rates are low.

However, the extent of over servicing being driven by consumers seeking unnecessary treatment remains unclear.

One problem in identifying this is that consumers often have limited knowledge as to whether a health condition is serious and warrants medical intervention, or is trivial and will resolve itself. Even not knowing can add to stress levels, so many will opt to do the safe thing, and visit their doctor in any case. Indeed, public health messages promoted by governments often encourage consumers to visit their doctor even where symptoms may appear mild, for example, in relation to urinary tract infection.

Consumers are also encouraged to have regular check-ups as a preventative measure; check-ups for those aged 45-49 at risk of chronic disease and those over 75 are specifically funded under Medicare, even where no specific symptoms of illness are present.

Meanwhile, the extent of over servicing driven by doctors is better understood.

The Professional Services Review was established to identify instances of inappropriate medical practice, including inappropriate billing of Medicare by doctors. Broadly, the PSR utilises a range of tools to determine if a doctor is engaging in inappropriate practice, including if a doctor varies from a ‘prescribed pattern’ of service. If a doctor exceeds performing 80 or more professional services over a 20 day period in any given year, this is deemed inappropriate practice.

The most recent annual report of the PSR shows that in 2012-13, some 45 cases were referred to the PSR for review (up 50% on the previous year). Some 16 cases were dismissed, while repayment orders were issued for 19 cases, totalling benefits worth just over $1 million.

While per capita utilisation of Medicare services continues to increase overall, the picture with general practice is less clear. Over the last decade the highest number of Medicare GP items of service claimed per head of population was in 1998-99, at 5.5 visits per person according to the Australian Institute of Health and Welfare’s 10 year data tables.

Attendance then decreased to a low of 4.87 visits per person in 2003- 04. This fall prompted concerns over equity of access, leading to the implementation of measures to address this (including incentives for bulk billing certain groups).

In 2010, general practice attendance rates grew to 5.3 visits per head of population according to AIHW (although recent data is not available). This raises questions over the extent to which an over servicing problem exists in general practice.

An ageing population, rising levels of chronic disease, new medical technologies and the emergence of targeted medical interventions have all been cited as driving increased service utilisation—as has inappropriate medical practice and doctor shopping. However, the evidence around over servicing driven by consumers remains thin. In addition, current health messages that are configured to encourage consumers to seek medical advice if they are unsure about a health condition would potentially conflict with the imposition of a patient co-payment.

 

 

Comments 2

  1. Trevor Kerr says:

    Take one male, age 60+, with mild hypertension, chronic low back pain and mild prostatism, currently taking four medications daily. (That is, a fairly ordinary set of problems for that demographic.) What’s the ‘ideal’ number of occasions per year for that individual to be calling in on the GP? Co-payment may not apply, of course, but until there’s a better understanding of how modern medicine is transacted, talk of co-pay has little to do with healthcare, and much to do with a distorted and ugly view of economics.
    Another grouping of consumers may be those who have silent abnormalities (no symptoms) who would benefit from early diagnosis leading to correction by medical treatment and/or lifestyle changes. The co-pay will have no effect on this group who have no motivation to attend, anyway. But, it’s this group who should be identified so that early detection and intervention can lead to improved (and cheaper) outcomes. Who wouldn’t want that to happen? Well … who benefits from later presentations with overt disease that have to be managed (expensively) in the ‘illness’ industry?
    It’s that group (with silent abnormalities indicative of progressive disease processes) that should be encouraged to attend. Since one of the predictable outcomes of them waiting till disease is apparent is a bigger burden on the public purse, maybe they should be *paid* $6 instead of penalised, even if they turn out to be ‘Worried Well’. (I stole that idea from Dan Ariely’s book Predictably Irrational.)

  2. David Dahm says:

    This video https://www.youtube.com/watch?v=M-n5Q7MnL0E best summarises what is really wrong with healthcare female GP’s are being deregistered for over servicing based on statistics because they run speciality clinics. Doctors have been bullied where there is no system that is peer agreed or monitored. The video highlight some key issues which remain a national scandal. Is was involved in the PSR hearings and my recommendations were in the final Parliamentary hearings. Yes there is a cover up watch the video closely https://www.youtube.com/watch?v=M-n5Q7MnL0E

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housing
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences