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Support growing for GP co-payments? Not so fast

Do Australians really support a measure to pay a nominal fee for bulk-billing medical care? The polls say otherwise.

The opinion poll released on Monday in the Fairfax media is being interpreted by some commentators as supporting the proposal for a GP bulk billing co-payment, reportedly under consideration by the Abbott government. About half of the people polled said they supported charging a means-tested co-payment for bulk-billed GP services. The same proportion of people also supported the government taking action to “curb the cost of Medicare”.

Opinion polls have their uses, but caution should be exercised when interpreting the results of this poll as a vote for shifting healthcare costs from governments to consumers. People cannot make an informed and genuine choice about how they would prefer to pay for healthcare unless they are presented with a range of competing options, along with their benefits and disadvantages.

A more useful question to ask would have been “if we need more money for our health system would you support raising it from progressive taxation or increased consumer co-payments?”. This at least would have allowed people to express their preference for one source of additional funding over another.

The poll result also needs to be interpreted in the light of international research about the impact of co-payments on health service utilisation.

Most people are probably not aware of the international evidence showing that increasing co-payments for primary healthcare will not reduce our overall healthcare costs. In fact, according to some studies, it may increase total healthcare expenditure by creating access barriers to the most cost-effective form of care.

The poll also reinforces the false view that Australia’s health budget is “out of control”. Again, this is not supported by the evidence or reflected in consumer behaviour. Both governments and individuals are spending more on health that we did a decade ago, but on current trends the figures show that our spending is sustainable. Most people are probably not aware that Australia’s health budget is around average for industrialised countries and that for this level of expenditure we obtain better-than-average results.

The fact that half of those polled agreed that action needs to be taken to reduce our health budget is more likely to reflect the success of the government’s strategy to convince us that drastic action is required than any realistic assessment of our current level of health spending.

Had the poll asked “should Australia continue to spend around the OECD average on healthcare, as long as this delivers good value to the community?”, it no doubt would have obtained a different result.

In fact, the one area in which we are not performing well is in the demands we place on individuals to fund their own healthcare. By international standards our individual contributions to healthcare costs are high. Australians pay for a higher proportion of our healthcare directly than do citizens of most other Organisation for Economic Co-operation and Development countries, including the United States.

There is good evidence that direct consumer payments in our health system are already causing access barriers to vulnerable people and that increasing existing payments or introducing new ones is likely to make this worse.

Recent research by the Consumers’ Health Forum found that families are being forced to choose which of their sick children to treat as they are unable to afford medicine for all of them. Other people reported forgoing essentials such as food in order to afford their health bills.

Many Australians are not aware of this situation because the burden of these individual payments fall primarily on those who have a chronic illness or disability. The voices of these people are often not reflected in opinion polls and consultation processes simply because they are often too busy dealing with the immediate problems related to their conditions.

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