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GP co-payment is dead so what next for health funding cuts?

After a loud and consistent protest from doctors, patients and public health experts, the Government's co-payment plan is officially dead.

Health Minister Sussan Ley listened to the almost universal concerns that a co-payment could reduce access to health care for vulnerable groups and the chronically ill.

But she said the freeze on rebates for doctors would remain frozen while negotiations on future health funding changes continued.

That has many public health and consumer experts worried.

Groups like the Public Health Association of Australia say as long as the Medicare rebate is frozen, doctors are likely to raise their fees.

Australian Health Care Reform Alliance chairman Tony McBride said the freeze on GP payments would force doctors to introduce co-payments over time.

"Our alliance of community, consumer and health groups call on the Government to end the freezer now, rather than in 2018," Mr McBride said.

The Rural Doctors Association of Australia (RDAA) also welcomed the dropping of the co-payment but said while the freeze remained in place, the financial viability of many rural practices would remain under significant threat.

"Many rural patients will continue to find it extremely difficult to access health care," RDAA president Professor Dennis Pashen said.


*New funding models mooted*


Also on the agenda could be a possible change to how visits to the GP are paid for.

At the moment, it is a fee-for-service model.

But there are hints that the Government might be considering a plan where doctors are paid a lump sum payment, particularly to look after patients with serious illnesses.

Similar systems were used in some overseas countries to encourage doctors to work with patients on improving their health.

Australian Healthcare and Hospitals Association chief executive Alison Verhoeven said so-called bundled care was something they have been calling for.

"We hope any policy changes would focus not only on budget savings but on building a better and more efficient health system, that is patient centred, better integrated and focused on the equity of access and affordability, including ensuring out-of-pocket costs are offset by appropriate safety nets," she said.

From 'co-payment' to 'price signal'

Since Health Minister Sussan Ley took over from Peter Dutton, the language around charging patients more to see a doctor has softened, from co-payment to terms like price signal or value signal.

She met with doctors, patients and public health groups in what was seen as a more consultative approach than her predecessor.

Also new to the discussion was the idea that any contribution would be levied based on income, an idea previously dismissed by Mr Dutton as unworkable.

"We remain committed to a value signal in health where there is a patient contribution that relates to the patient's ability to pay," Ms Ley said previously.

But health experts said asking people to pay more for healthcare inevitably leads to some people putting off seeking medical treatment.

Policy expert Dr Anne Marie Boxall said while there were safety nets built in to ensure cost did not prevent people on lower incomes from accessing necessary health care, there was mounting evidence to suggest that they were not completely effective.

Dr Boxall's paper titled What are we doing to ensure the sustainability of the health system? made several findings.

"An Australian Bureau of Statistics (ABS) survey in 2009 on patients' experiences of health care found that a substantial number of people were deferring or forgoing treatment because of the cost," the paper said.

"The survey found that in the previous year, concerns about the cost of care meant that:

  • 1 in 16 people delayed or sacrificed treatment from a GP

  • 1 in 11 people delayed or did not fill a prescription

  • 1 in 10 people delayed or sacrificed treatment from a specialist."

If co-payment is killed off, what measures are being considered?

Health groups have been aiming to broaden the discussion, from focussing on primary care like GP services to the more expensive end of health care, namely hospitals.

Stephen Duckett from the Grattan Institute said the Government could save billions of dollars by reducing inefficiencies in public hospitals as well as reviewing how the Government pays for medicines.

Other experts have suggested the Government look at removing subsidies for expensive and outdated items on the Medicare Benefits Schedule.

The Government said it would not introduce major changes to health spending without consulting with doctors groups such as the Australian Medical Association.