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Is a co-pay such a bad thing? Is a $6 fee to see your GP such a bad thing?
(35 minutes later)
As a GP, I find the outrage directed at the concept of a co-pay to visit a GP intriguing. In health policy, it is not typical for a proposal to be met with universal derision – so does the sight of politicians, health advocates and doctors’ groups singing the same Christmas carol signal a particularly bad policy? Maybe –but I hope it also starts to change our mindsets and how Australians view their health system.As a GP, I find the outrage directed at the concept of a co-pay to visit a GP intriguing. In health policy, it is not typical for a proposal to be met with universal derision – so does the sight of politicians, health advocates and doctors’ groups singing the same Christmas carol signal a particularly bad policy? Maybe –but I hope it also starts to change our mindsets and how Australians view their health system.
How our health policies are implemented is a real problem, and one we should concentrate on. For example, recent policies aiming to improve access for people with chronic diseases or mental illness to dental or psychological services were subjected to significant cost blow outs, resulting in the axing of one program and the curtailment of the other.How our health policies are implemented is a real problem, and one we should concentrate on. For example, recent policies aiming to improve access for people with chronic diseases or mental illness to dental or psychological services were subjected to significant cost blow outs, resulting in the axing of one program and the curtailment of the other.
To think a saving of under $200m a year will be achieved by a co-pay, and that demand for GP visits will decrease by 3% as a result, is unlikely. In reality, human behaviour will adjust. Patients will create shopping lists of medical problems so they get their “money’s worth”, thereby clogging up appointment books, or will attempt to avoid the co-payment by requesting prescriptions, referrals and paperwork over the phone. In many instances, doctors are likely to waive the co-payment to ensure repeat custom or adjust their practice style to exempt shorter, simpler consultations from co-payment in order to maintain both patient throughput and their business’s viability. I don’t know any GPs who would turn patients away on the basis of their ability to pay, and this will not change.To think a saving of under $200m a year will be achieved by a co-pay, and that demand for GP visits will decrease by 3% as a result, is unlikely. In reality, human behaviour will adjust. Patients will create shopping lists of medical problems so they get their “money’s worth”, thereby clogging up appointment books, or will attempt to avoid the co-payment by requesting prescriptions, referrals and paperwork over the phone. In many instances, doctors are likely to waive the co-payment to ensure repeat custom or adjust their practice style to exempt shorter, simpler consultations from co-payment in order to maintain both patient throughput and their business’s viability. I don’t know any GPs who would turn patients away on the basis of their ability to pay, and this will not change.
So why would I support a co-pay if I believe it will not make a significant impact on health spending? Because while the policy is underdeveloped, it does trigger a debate on a number of issues that have been avoided by many governments, but which we need to urgently tackle nonetheless.So why would I support a co-pay if I believe it will not make a significant impact on health spending? Because while the policy is underdeveloped, it does trigger a debate on a number of issues that have been avoided by many governments, but which we need to urgently tackle nonetheless.
Firstly, the current attitude that a universal health system is a right and not a privilege needs to change. Health care is enormously expensive, but rarely does the public see these costs. I often point out to bulk-billed pensioners who receive hormone injections as part of their treatment for prostate cancer that the 10 minute visit to administer their expensive treatment costs the tax payer about $2,000. I often wonder if the family who want their dear mother to convalesce in the public hospital another night, as tomorrow would be a more convenient day to take her home, are aware of the $1,000 a night price tag. I hope most doctors ponder the cost of that additional blood test or scan, and whether spending an extra $400 changes the management of the patient before them. With our ageing population and the increasing disease burden that follows, at some point the health dollar must be rationalised. Opening the wallet to make a small contribution to their care makes the cost of universal health care momentarily visible to the user.Firstly, the current attitude that a universal health system is a right and not a privilege needs to change. Health care is enormously expensive, but rarely does the public see these costs. I often point out to bulk-billed pensioners who receive hormone injections as part of their treatment for prostate cancer that the 10 minute visit to administer their expensive treatment costs the tax payer about $2,000. I often wonder if the family who want their dear mother to convalesce in the public hospital another night, as tomorrow would be a more convenient day to take her home, are aware of the $1,000 a night price tag. I hope most doctors ponder the cost of that additional blood test or scan, and whether spending an extra $400 changes the management of the patient before them. With our ageing population and the increasing disease burden that follows, at some point the health dollar must be rationalised. Opening the wallet to make a small contribution to their care makes the cost of universal health care momentarily visible to the user.
Secondly, we need to change our attitude to Medicare. It is a public health insurance scheme to which we are all policy holders, and our behaviour determines to what degree our premiums increase yearly. Other forms of insurance provide a good example of the problems we face. The other week, my car was nudged by another vehicle and sustained a small scratch. As the other driver was at fault, I made a claim against his insurance to get the scratch fixed. I simply turned up to the panel beaters, they fixed the scratch, offered to detail a few more scrapes at no cost to me, and I signed an insurance claim and walked out. Fantastic! And this is how most of us interact with Medicare. We don’t see the costs, but we all pay. The at-fault driver’s premium goes up and costs are defrayed across all policy holders in the form of rising premiums. It encourages us not to think before we make a claim as in most cases, we don’t pay or pay very little. If I had scratched my car and faced a co-payment to fix it, I would think twice about how really necessary that repair job is.Secondly, we need to change our attitude to Medicare. It is a public health insurance scheme to which we are all policy holders, and our behaviour determines to what degree our premiums increase yearly. Other forms of insurance provide a good example of the problems we face. The other week, my car was nudged by another vehicle and sustained a small scratch. As the other driver was at fault, I made a claim against his insurance to get the scratch fixed. I simply turned up to the panel beaters, they fixed the scratch, offered to detail a few more scrapes at no cost to me, and I signed an insurance claim and walked out. Fantastic! And this is how most of us interact with Medicare. We don’t see the costs, but we all pay. The at-fault driver’s premium goes up and costs are defrayed across all policy holders in the form of rising premiums. It encourages us not to think before we make a claim as in most cases, we don’t pay or pay very little. If I had scratched my car and faced a co-payment to fix it, I would think twice about how really necessary that repair job is.
Finally, we need to appreciate our health system. Health care is the most significant expense most developed nations face yet most of us have little idea how it all works. We bemoan its shortcomings and fail to appreciate how lucky we are to have it. We have better health than the majority of the world, yet we grumble about emergency waiting times, paying a few dollars for drugs that cost thousands, and the quality of hospital food. In my experience, the components of our health system work extremely well and we by and large live long, healthy lives.Finally, we need to appreciate our health system. Health care is the most significant expense most developed nations face yet most of us have little idea how it all works. We bemoan its shortcomings and fail to appreciate how lucky we are to have it. We have better health than the majority of the world, yet we grumble about emergency waiting times, paying a few dollars for drugs that cost thousands, and the quality of hospital food. In my experience, the components of our health system work extremely well and we by and large live long, healthy lives.
As the New Year approaches, I would like to raise a glass and toast the continued viability of our excellent health system. Even if it costs me five dollars to fill it.As the New Year approaches, I would like to raise a glass and toast the continued viability of our excellent health system. Even if it costs me five dollars to fill it.
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