Cabinet expenditure committee looking at GP co-payment budget plan

A doctor copayment would form part of a user pays approach favoured by Treasurer Joe Hockey. AAP/Lukas Coch

Patients could be up for a co-payment of around $5 when they visit the doctor under a plan being prepared for next month’s budget.

The co-payment would save the budget billions of dollars over the medium term.

While the government appears minded to go ahead with the co-payment, the cabinet expenditure review committee has yet to make a final decision, and some details, including how to protect low income earners, are still to be nailed down. The ERC is expected to consider the proposal again next week.

A centrepiece of changes to put health spending on a more sustainable basis, the co-payment would be part of the user pays approach favoured by Treasurer Joe Hockey, who said on March 31 that higher income earners should contribute to the cost of their health care. He said he had tried to pay when he went to bulk billing doctors but had not been allowed to do so.

One complication is that, to discourage people avoiding the payment by going to hospital emergency departments, there would need to be a co-payment there for services that were not actual emergencies.

But hospitals come under state governments and the Medicare agreements with the states provide for no charges to be made These agreements would have to be varied.

The Australian Medical Association used to support a co-payment but now opposes it. But the government believes the AMA membership would not be against it.

AMA president Steve Hambleton said a GP co-payment would be directed to a non-problem.

“GP costs are not the problem,” he said. There was a need to improve chronic disease management in GP practice but a co-payment was not the way to do it. “We think that with a co-payment there will be just as many necessary visits avoided as unnecessary ones, with perverse outcomes. People will delay, when they should go to the doctor, and they will divert to more expensive alternatives – emergency and ambulance services.” He said two states had already said they would not charge in emergency.

Tony Abbott promised before the election that the health budget would not be cut, but left the way open for savings in individual areas of that budget.

The co-payment works by the government reducing the Medical Benefits Schedule fee but mandating a charge above this so doctors are not worse off.

The former government last year announced an MBS indexation pause – taken over by this government – from November to July which saves $664 million over four years.

Health Minister Peter Dutton has written in the latest issue of the Consumers Health Forum’s Health Voices that a 1980s Medicare model was still being used. “We need to modernise and strengthen Medicare and in so doing help to heal our health system,” he writes.

He reiterates that while all components of federal health spending have risen, the fastest growing element has been Medicare payments.

In 2012-13 the Commonwealth spent $18.6 billion on Medicare payments, an increase of 5.3% from the previous year, although the population only grew by 2.6%.