The decision to freeze Medicare payments until 2018 will cost Australians about $10 - double the government's failed copayment - every time they visit the doctor.
Doctors say the freeze will affect the quality of care. General practitioners will be forced to either charge patients more for consultations because medical practices can no longer absorb the cost of running local medicine or see more patients to ensure consistent income.
New research published in the Medical Journal of Australia on Monday today reveals that GPs' income will decline for each consultation. GPs will be at least $4 worse off for each patient, but because they usually only charge a gap to non-concessional patients, they will be forced to charge a minimum of $8.43 or absorb the cut of 7.1 per cent.
Chris Harrison, lead researcher and senior research analyst at the Family Medicine Research Centre at the University of Sydney, says: "The government is now forcing GPs to hold the hat out."
And Stephen Duckett, health program director at the Grattan Institute, says the continuation of the freeze is the government's way of enforcing a policy of patient contribution.
"It's a copayment by stealth and a lazy set of savings," he said. "The current business model for GPs can't be expected to absorb a change of that magnitude."
In the 2012-13 year, 85 per cent of Australians visited the doctor, said Duckett. Compared with the OECD average, Australia is on the lower side of cost and on the higher side of life expectancy.
Internationally, the direction of public policy is to strengthen general practice because it saved money further along the health chain, he said.
The average cost of a general practice visit is about 1 per cent of the average hospital stay and about one-sixth of a visit to a hospital emergency department.
The Royal Australian College of General Practitioners has called for the federal government to overturn the freeze and reinstate annual indexation on patient rebates.
The president of the RACGP, Frank Jones, says: "Our position is very clear, we do not want the freeze to continue - it will ultimately impact patients, who will be forced to bear the cost of this policy."
He said costs rose every year and GPs could not absorb the increasing costs associated with the delivery of quality healthcare.
"The freeze is, in effect, yet another barrier to patients accessing quality general-practice care," he said.
Dr Jones also said a RACGP survey of medical students, interns, registrars and new RACGP fellows showed that 64 per cent had been led, by the government's proposed changes, to reconsider their career path or interest in general practice as a vocation.
Dr Phill Cameron, a GP in Sydney's inner city, says the scheduled fee is a pitiful amount. "It's why a lot of GPs have not been able to sustain bulk billing.
"You either have to cut back on what you provide in terms of quality of care or charge patients more out of their pockets to cover it," he said. "There will be increasing pressure on GPs in smaller practices, particularly in disadvantaged areas."
The new research says the estimates of increased cost are conservative and cannot predict the amount GPs will charge once they are forced, for economic reasons, to introduce a copayment.
"The freeze will result in Medicare savings," say the authors. "However, patient out-of-pocket expenses will be higher than these savings because GPs will need to charge more than their lost income in order to recoup the additional implementation and operational costs we have discussed."
The government does not need to pass legislation for the freeze on Medicare payments.