Discreet regulation changes bring in co-payment by stealth

Your parents will pay more for healthcare. Or they will put off going to the doctor (and we know how hard it is to get your dad to go already).

The federal government is continuing to attack access to affordable healthcare in this country.

Last year, when the LNP tried to impose a $7 co-payment, Australians rose up. They wrote to their local members, they went on talkback, they tweeted and they Facebooked.

The co-payment died. Now the government is trying to reintroduce it by stealth.

Here's what's happening.

Number 1: Effective January 19, there will be changes to how much doctors get for visits, depending on the length of time you are in there.  Basically, doctors will get less depending on how long you spend together. There have always been consultations A and B. Level A was for quick and dirty – simple, less than five minutes. Level B was for most consultations, required a bit of chat and a bit of a poke around your various bits and pieces. Now, the level of rebate you will get for those visits in between six and nine minutes will be reduced from around $37 to around $16. The doctor will be worse off.


The federal government made this change through regulation. The only way to reverse it is through a disallowance when the Senate sits in February. Don't know the phone number of your local friendly politician? Here, let me help –

Number 2: Effective July 1, also changed through regulation, the government will cut rebates to GPs by $5, therefore imposing the co-payment we – none of us with the exception of the Liberal National Party – ever wanted. And you can only imagination how the GPs will recoup that money – yep, co-payment by stealth, forced upon them by the government.

Number 3: Freezing the annual indexation of the Medicare benefit schedule. This is another one of those appalling collaborations between Liberal and Labor. The Labor Party first implemented this freeze two years ago and now the LNP wants to extend it by another four years.

Nothing else is frozen. We still have a (slowly) rising consumer price index and inflation. But the GPs, who face us all snotty, sneezing, wheezing, coughing, spotty public every day and every hour, their pay is frozen.

And the government has done no modelling to see what the impact of these changes will be. None. They haven't consulted with leading researchers in the area. They've consulted with balance sheets.

This is an ideological and spiteful decision by politicians who were thwarted in their last attempt to make change. Now, during the period of time in Australia where we are occupied with our families or with attempting to spend time away, regulations were altered so the government could get its own way.

How long do doctors spend with their patients?

Christopher Harrison, a senior researcher at BEACH, Australia's largest study of general practice activity, says just 26 per cent of timed consultations are less than 10 minutes, but these consultations only account for 12 per cent of total time spent in consultations. So folks, six-minute medicine barely exists.

"It gets more airtime than it deserves," he says.

The majority of us (nearly 60 per cent) spend somewhere between 10 to 20 minutes with our doctors and that takes up around 60 per cent of the total consultation time.

So, doctors will either rush us through (to qualify for the A level) or spend even longer with us than they need to.  Whenever I visit my darling Dr Pandora, the waiting time is so awful I take my laptop with me so I can work until she calls me in. The waiting times are already long and I'm a patient in a highly privileged inner-city area (and my co-payments are around $40).

This is a direct attack on GPs and a surreptitious attack on Australians who visit those GPs. We already have a GP crisis in Australia in rural or regional areas.

Stephen Duckett, director of the health program at the Grattan Institute and a former senior public servant, says these changes will further discourage medical students from entering general practice.  He tells the story of when ophthalmologists were faced with cuts to rebates and they mobilised public opinion. The Labor government was forced to back down. He says that the general practitioners are not as focused – instead, they will just pass the cost on to patients.

"It will ensure consumers have less access to bulkbilling, they will have to pay the gap," he says.

But there will be other costs, says Duckett. Patients will put off visiting the doctor and only visit when diseases are more advanced. Already, he says, we put off visiting the doctor.

The federal AMA  has called for an immediate reversal of the three changes.

Stephen Parnis, the vice-president of the AMA, says: "You need to invest in this area rather than cut."

The AMA usually loves whatever the LNP has to offer so let's take these proposed changes seriously. Get  your MP on speed dial – and your senator – and make them understand they will be the ones to pay.

Richard Denniss, director of the Australia Institute, says he can't quite believe that the federal government is making these changes just as Campbell Newman is attempting to get re-elected. "Why do you want to discourage people from going to the doctor ... why would you use a price signal?"

Let's hear from two people at the very centre of healthcare in Australia.

Michelle Vollmerhause is a GP in Townsville – she's worked there for nearly 15 years. If the changes go through, she says she will stop bulkbilling children and those on the aged pension.  She is telling her patients about the proposed changes and they are surprised.

"If you take that much out of the system, it will take flexibility away."

And what of patients? John Borlini, not far from Bunbury in Western Australia, has just retired from work to look after his wife who needs full-time care. "I think about [the cost of healthcare] all the time ... without bulkbilling, it would be harder to survive."

And what does the minister's office say? Sussan Ley was handed these changes by Peter Dutton and she's on leave until the end of the week.

Her spokesman said the minister had already met with the AMA and would continue to consult doctors and the broader community about changes.  The spokesman also said this included the importance of addressing six-minute medicine by ensuring Medicare rebates more accurately reflected the time a doctor spent with their patient.

Six-minute medicine. The experts say it barely exists.

So why does the minister disagree?

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