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Co-payment will hit harder than expected, Sydney University study finds

Treasurer Joe Hockey has faced criticism for the Medicare co-payment. AAP/Joe Castro

The government’s proposed Medicare co-payment and its increase in the pharmaceutical benefits scheme threshold will send a bigger-than-anticipated price signal, according to a study by Sydney University general practice researchers.

If both policies were introduced, the average annual extra cost to a patient, which increases with age, would be A$36 for children up to $122 for people 65 and older.

A young family of four would expect to pay $170 in co-payments for GP visits and tests, plus $14 for medications – $184 more annually.

A self-funded retired couple without Commonwealth concession cards could expect to be up for an average of $189 in co-payments for GP visits and tests, plus $55 for medications – totalling $244 more.

An age pensioner couple with concession cards would pay an average $140 in co-payments for GP visits and tests plus $59 for medications – $199 extra.

The research comes as the Medicare co-payment faces defeat in the Senate with Clive Palmer reaffirming his opposition.

The researchers – Clare Bayram, Christopher Harrison, Graeme Miller and Helena Britt – are from the Family Medicine Research Centre at the Sydney School of Public Health. They used data from the Bettering the Evaluation and Care of Health (BEACH) program which is a continuous national study of general practice activity. The researchers say they have been conservative in their assumptions.

They found that more than one-quarter of adult GP consultations involved at least one test, which would make for a minimum out-of-pocket cost for the consultation of $14 in co-payments. About 3% of adult GP consultations involved imaging and pathology – making for a minimum $21 in co-payments.

Different people use health services at different rates, with the average number of GP visits made by the Australian population who visited a GP in 2012-13 being 6.6. The rate increases substantially with age, from an average of 4.5 for children to 10.5 for people 65 and over. A similar age-related pattern applies for pathology services.

“Therefore, the introduction of co-payments will not have an equal impact across the population. It is the high users, usually the older, sicker people in our community who will be the most affected,” the report said.

The co-payment would change patterns of health service use, with different impacts for different patient groups .

“Compared with other OECD countries, Australia already has one of the highest levels of out-of-pocket health costs. Through introduction of the co-payments the government aims to ‘ensure health services are sustainable and used efficiently’. However there is no evidence that any modelling was performed to assess the effect of co-payments on deterring people from seeing a GP, or the flow on effect on hospital emergency department attendances.”

In 2012-13, 5.8% of people delayed or did not see a GP because of cost, and this was a greater barrier for those from disadvantaged areas.

“Discouraging people from using primary care health services flies in the face of all international evidence.

"It is likely that the increased costs due to these policies would deter more people from seeking early treatment or from taking necessary medications. This is a concern when areas in Australia already have 13% of their population delaying or not seeing a GP due to cost, and 15% doing the same for prescriptions.

"Overseas studies have shown that there is little evidence of health care care cost reduction from introducing co-payments. The evidence suggests that long term health costs will be higher due to patients deferring necessary care, resulting in increased hospitalisation and progression of disease,” the study said.

“International evidence overwhelmingly suggests that the most efficient, effective and equitable health systems have a strong primary care focus.

"We believe that if Australia is to maintain an efficient and equitable health care system, general practice requires investment, not reductions.”

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