14 November, 2023
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Australian citizens typically expect most of their medical costs to be covered by Medicare when they’re unwell. However, patients have been increasingly expected to contribute to the cost of visiting their general practitioner (GP) in recent years. Patients typically contribute to the cost of their GP visit via a “co-payment” or “out-of-pocket” expense, on top of the $41.40 already contributed by Medicare for a standard visit. This article will explore the history and intention behind GP co-payments, including the implications of these out of pocket expenses for various stakeholders. These concepts are important for you to understand, as they can improve your knowledge of the state of the medical system in Australia. Such knowledge may improve your performance in a range of tests, including but not limited to GAMSAT essays and your eventual medical interview. For instance, it is not uncommon for medical interviewers to ask medicine applicants to discuss an issue in medicine that particularly concerns them. This knowledge is also important for general conversation, networking and advocacy.
GP co-payments were initially introduced under the name ‘Mach 1’, as part of the 2014 Federal Budget. Patients were expected to contribute approximately $7 to the cost of each GP visit following this change. This measure was introduced to save costs, since healthcare expenditure is expected to continue ballooning as the population ages. Many changes to the GP co-payment ensued thereafter, leading to the current state of GP billing policies.
Whilst not professionally expected, many GPs still choose to “bulk bill” concession card holders. In other words, generous GPs often allow the most vulnerable in society (as measured by whether they have a concession card) to forgo the co-payment.
The GP co-payment significantly impacts a range of stakeholders. Firstly, and most importantly, patients themselves are impacted by the expectation of paying $60 out of pocket per GP visit. Namely, this substantial cost can make patients feel hesitant to visit their GP, thus leading to less preventive healthcare, such as routine monitoring for hypertension and screening for cancer. Hence, patients are likely to receive diagnoses at the later stages of disease, when their treatment options and prognosis may be more limited. Additionally, patients struggling financially may not be able to visit a GP for management of their already diagnosed conditions. For instance, a low income patient with diabetes may forgo taking their prescription medication until they have enough money to cover the expected co-payment. Such non-compliance with recommended treatments, although not the patient’s fault, can lead to ongoing deterioration and impacts on quality and length of life.
Another major stakeholder affected by the expectation of making GP co-payments is the healthcare system and its workers. Whilst having patients contribute to the costs of their own medical treatment may alleviate healthcare costs and workload in the short term, this measure does not necessarily achieve its aim of decreasing healthcare expenditure in the long term. For instance, it is much more expensive to treat a late stage cancer, than pick it up during healthcare screening. An increased frequency of visits to secondary (specialist) and tertiary (hospital) healthcare settings is more expensive overall than receiving accessible primary healthcare from a qualified GP. Healthcare workers themselves, including GPs, practice nurses and medical receptionists are also more likely to burn out and underperform if constantly under the pressure to negotiate prices with financially struggling patients. Since the rebate per unit time is lower for longer consults, GPs are also incentivised to see as many patients per possible during the day, thus not giving enough time to some patients that may have complex needs and decreasing their quality of care.
There are many groups of patients that have historically struggled to find accessible, equitable healthcare. These marginalised groups include 1) women, 2) members of the LGBTQIA+ community, 3) rurally based patients, and 4) culturally and linguistically diverse individuals (including refugees and First Nations patients). The reasons that healthcare can be difficult for these groups to access are complex, but include cultural differences, language barriers, geographical distance, psychologically unsafe environments and financial issues. The introduction of co-payments adds another barrier to receiving care for these historically disadvantaged groups, especially since many of them may not fit into the strict criteria for “bulk billing” (that is, usually holding a concession card).
There are many possible alternatives to expecting patients to contribute to the cost of seeing a GP. Firstly, this expected co-payment could be scrapped, as to promote visiting your GP for preventive care rather than presenting to hospital later, when your disease is more advanced. Alternatively, the government has recently invested in upskilling other healthcare workers to perform some of the tasks traditionally performed by GPs, thus decreasing their workload and increasing the accessibility of affordable care. For instance, pharmacists have recently been given the power to prescribe some medications. There is also ongoing debate as to whether nurse practitioners (nurses with some extra qualifications) should be given similar tasks to GPs, including prescribing rights. Some argue that these changes may decrease the quality and continuity of care for patients. However, increasing accessibility is also important. I’d encourage you to do some more reading, to form your own opinion on the various alternatives to GP co-payment not discussed in this article.
In summary, GP co-payment is the increasingly common expectation that patients should contribute to the cost of their own treatment via an “out of pocket” payment. This measure was introduced, as to decrease healthcare costs in Australia. However, many argue that GP co-payments actually increase healthcare expenditure overall, since they discourage patients from seeking preventive healthcare. There are many possible alternatives to the GP co-payment. I’d encourage you to do some extra reading on this issue, as to improve your knowledge of the Australian medical system. Such knowledge may improve your GAMSAT score and eventual performance on the medicine interview!
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