A co-payment is bad health policy that could be deadly | OPINION

THE health measures in the federal budget are almost universally opposed by the people who provide health services in Australia, and the Australian Medical Association is at the forefront of this.

The message is clear: the measures add up to bad health policy. The health of Australians is too important for healthcare to be an ideological toy.

While the Australian Medical Association strongly represents the interests of doctors, we will always put the interests of our patients first. This is our professional obligation and is why we oppose the budget measures. They will hurt our patients, especially the sickest and most vulnerable.

The association is supportive of some co-payments, but not the one proposed by the government.

The co-payment applies to general practice, pathology and diagnostic imaging. But there are also two other troubling elements — a $5 reduction in the patient Medicare rebate and the loss of the bulk-billing incentives (higher Medicare rebates to patients to encourage bulk-billing) for diagnostic imaging and pathology.

In about 50 per cent of cases, pathologists never have contact with the patient. For outpatients, the specimen may be sent by the doctor, which makes the co-payment logistically impossible.

This is a real problem, especially for small pathology practices, many of which are in rural areas.

In diagnostic imaging, the issues are even more significant. The loss of the 10 per cent bulk billing incentive, as well as the $5 rebate cut, means radiologists face much greater losses. The patient will have to pay the whole amount for the test and claim the rebate afterwards. Diagnostic imaging practices that provide excellent services in disadvantaged areas will become unviable.

Anyone working in health understands the basic premise that prevention is not only better than cure, it makes economic sense.

Diagnosing and managing chronic disease properly in general practice keeps patients out of more expensive hospital care.

This proposal poses a financial barrier for vaccinations and other preventative healthcare measures and chronic disease management.

The recent COAG Reform Council report showed that, among the more disadvantaged in society, 12 per cent of people defer or do not see their GP due to cost. That will significantly increase.

It is already hard to secure GPs for aged care. It is impractical to collect co-payments in this setting, particularly from patients with dementia. If they get sick or can’t see a GP, they end up in an emergency department. It’s an expensive problem now but would get worse.

Indigenous people are three times more likely to die from a potentially avoidable cause. Recent evidence indicates 12.2 per cent of indigenous Australians do not access a GP because of cost.

The cumulative effects of the $7 co-payment can be significant, even for a routine diagnosis.

Take a woman with a breast lump who needs a biopsy. As the impacts of the co-payments for GP, radiology, and pathology add up, the cost rises to at least $63 over nine visits. For some patients, this will deter them from accessing care and completing investigations. The effects of delayed diagnosis are expensive and often tragic.

What about the common scenario of the patient on warfarin? Not all of these patients will be under the cap of 10 co-payments for concession patients. There is usually a large number of visits for ratio testing to determine whether the blood is too thin or thin enough.

Another reason for the AMA’s response is the lack of evidence. Modern medicine is evidence-based. We are trained not to accept blind assertions or opinion in determining the best treatment without the supporting evidence.

The co-payment is unfair and unnecessary. Ideology has pushed this proposal too far. It is poor health policy. The Prime Minister should step in and scrap this policy. If not, it deserves to fail in the Senate.

Associate Professor Brian Owler is president of the Australian Medical Association.

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