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Five more reasons we should not have co-payments on GP visits

The GP co-payment had a brief period in the sun recently when the MRFF Action Group was formed to support the medical research fund.

The health sector was quick to respond that while the Medical research fund was a positive development its funding source was unacceptable.

In a press release, Alison Verhoeven, Chief Executive of AHHA, said:  “The AHHA agrees that increased funding for medical and health services research in Australia is of the utmost importance, however we cannot support this increased funding coming at the cost of affordable primary health care.”

Ms Verhoeven added: “Since the Budget in May countless organisations have described the negative consequences of introducing a co-payment for GP, pathology and diagnostic imaging services. The government has also indicated their interest in considering alternatives to their initial proposal so I cannot see how this action group can disagree with so many of their sector colleagues.”

One argument from those supporting the co-payment is that co-payments in health services already exist. In a press release in August, Finance Minister Mathias Cormann suggested that supporting a copayment on pharmaceuticals but not on GP visits is “irrational”.

Stephen Leeder argues that there are very real reasons not to impose the GP co-payment. Here he notes five particular reasons that stand out:

Stephen Leeder writes:

First, the co-pays on prescription drugs stop poorer people from accessing to them. Ask general practitioners. Extending co-pays to general practice compounds rather than solves this problem.

Second, seeing a doctor for a health worry is different to filling a script. A consultation with a doctor may dissipate the worry without further cost or action.

Third, a timely, uninhibited consultation for the first symptom – chest pain, let’s say – of a serious problem may save a life and nip the progress of a disabling illness. Co-payments diminish easy access for less affluent Australians to general practice

Fourth, a consultation may lead to preventive changes – quitting smoking, behaviour modification, stopping unnecessary medications – that are positive investments, not sunk costs.  Co-pays that inhibit preventive consultations diminish the chance of a healthy life.

Fifth, many general practitioners in poorer parts of the country who entirely bulk-bill do not have the financial systems to raise fees.  The logistics of collecting and remitting a co-payment could drive them out of business.

Maybe the co-pays on pharmaceuticals are a public policy error that permits gouging of pharmaceutical prices and diminishes the search for efficiency in drug supply. Rather than asking where else we can impose a co-payment, the question should be, “We don’t have co-payments on general practitioner bulk-billed consultations, so why should we have them on prescribed pharmaceuticals?’

Comments 1

  1. Tim Senior says:

    Stephen Leeder’s points are all good arguments against a co-payment, well expressed.
    I’d like to add a point 6, as well.
    Those who argue that co-payments are OK because we pay co-payments for prescriptions forget that one of the most successful measures of the Indigenous Chronic Disease Package was the PBS Closing the Gap co-payment which reduced or removed patient co-payments for PBS prescriptions.
    To quote the Menzies Sentinal Site report

    “Registration for the Pharmaceutical Benefit Schedule (PBS) Co-payment measure to improve Aboriginal and Torres Strait Islander people’s access to medicines exceeded expectations. This appeared to be encouraged by community demand and practitioners’ perceptions of the value of the measure.
    (p6 of the pdf here http://www.menzies.edu.au/icms_docs/189995_Sentinel_Sites_Evaluation_Summary_Report.pdf)

    In other words, both the previous and curent government have had policy in this area that if you want medications to have their effect, you have to remove financial barriers.

    I must admit to being hesitant to write this, as part of me wonders if the current government just haven’t noticed this policy yet, and pointing this out will result in removal of an effective policy to improve the health of Aboriginal and Torres Strait Islander people. So, if it’s OK, I’ll just ask you to whisper…

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