Since the Abbott government’s election, only one issue in relation to the future of Australia’s health system has been on the public radar.
That’s charging a minimum co-payment for general practitioner services, including those that are currently bulk-billed and free to patients when they go to the doctor.
The GP co-payment has dominated political discussion for over a year. It has become a key factor in the collapse of the political standing of Prime Minister Tony Abbott and his government. Few expected it to be a centrepiece measure in last year’s Budget, and fewer still expected the Frankenstein’s monster of a measure that the government put together.
December’s co-payment reboot, with doctors taking a $5 Medicare rebate cut across the board, plus a four-year rebate freeze as a stick to drive them to charge co-payments for those other than children, pensioners and concession holders, has run into a brick wall. Its co-payment plans have embroiled the Government in an endless brawl with the doctors’ trade union, the Australian Medical Association.
Indeed, after the Government’s capitulation last month over related plans to change the Medicare item structure for GPs, and the Labor opposition’s declaration that it would never change Medicare without the consent of the medical profession, it could be said that AMA national president Brian Owler is now de facto health minister.
Nevertheless, the Government’s rebooted co-payment plan remains on the table. New Health minister Sussan Ley has said that the Government remains committed to price and value signals in general practice.
Rightly, Ley hasn’t totally given up on pursuing the principle that if Medicare is about everyone paying according to their means that those with means should pay at least something. While critics of a GP co-payment point out that Medicare is perfectly sustainable now, they dodge the point that as we move towards mid-century, the bulk of baby boomers will reach the end of their lives and today’s “fat kiddies” will start reaping what they and their parents have sown.
Whether or not you want a GP co-payment, the debate over it has been fierce and polarising. If, as seems likely, the Government fails to get any significant related measure through an intransigent Senate, it still may lead to lasting results, whether a recommitment to the current principle of medical treatment potentially being free to all at point of access, or some acceptance that people who can afford to should contribute more to their healthcare costs. That in itself is a good thing.
"Whether or not you want a GP co-payment, the debate over it has been fierce and polarising."
What isn’t good is that co-payment controversy has swamped any rational policy conversation about the much wider structural reform Medicare needs to cope with mid-century demand pressures. As a result, we aren’t talking of rejigging health funding to reflect the best models of primary and acute care, such as the concept of a “medical home” where patients are central to a network of relationships with GPs and providers far better joined up and coordinated that what most families get now.
We aren’t talking about better information sharing between providers and patients, and about how to ensure that patients not only have comprehensive electronic health records, but how those records actually improve the quality of care as patients move to and from primary and hospital care.
And we certainly aren’t talking about ensuring that Medicare and other health funding reflects current best clinical practice, and rewards quality as well as quantity of services, so that patients are treated as people and not simply as clinical cases or revenue units by the “system”.
Co-payments and price signals should be considered too, but in a wider reform context rather than as the “magic bullet” the political firestorm has turned them into.
We need a broad Medicare reform conversation in a depoliticised framework, and the timing needs to be taken out of the Government’s Budget timetable. What matters is a comprehensive, careful and consultative process facilitating steady but palatable policy change. A major Productivity Commission inquiry, like that that has just made sweeping recommendations for funding childcare, is an ideal vehicle for that conversation.
In the meantime, Health minister Ley should drop the GP co-payment measures still on the table. They are dead ducks, and their continued presence frustrates meaningful dialogue between Government, patients and providers.
If we are to afford world-class and cutting edge healthcare well into this century, to take giant steps forward the Abbott government needs to take this one step back.
Terry Barnes wrote the think tank paper that started the GP co-payment debate. He appears on tonight’s episode of Insight on SBS, which explores creating an efficient patient-focused health system.
