The Co-payment debate – the GP aspect


 

All of the media statements are somewhat vague on exactly how this whole co-payment scheme is supposed to work – I suppose because the actual sources are purposefully vague.

Like many GPs we bulkbill a sizeable proportion of our patients and these changes will be game changers for us – I would hate to think how it will affect the large Bulkbilling emporiums

So lets look at what we do know of the current suggestions:

http://www.skynews.com.au/news/national/2014/05/01/audit-recommends–15-gp-co-payment.html

  • The non-concession patient will pay $ 15 per visit for the first 15 visits and $ 7.50 per visit after that.
  • Concession card holders/pensioners pay less
  • GPs CANNOT waive this out of pocket payment nor can patients insure against it

OK – so let’s look at the current situation that is in place:

  • We can charge a patient whatever we like in addition to a rebate – most privately billing Practices would charge around $ 70 for a non-concessional standard 5-15min visit
  • If we bulkbill a pensioner, child or concession card holder we get a bulkbilling incentive payment in addition to the current rebate
  • Medicare Rebates have not increased since November 2012 – bulkbilling income has therefore been static since then (unless you churn patients through at a faster rate)

Next let’s look at the elephants in the room – the unknown factors:

  • Most important unknown – is this co-payment part of the rebate or in addition to the rebate
  • What are we supposed to do with a patient who has NO money and we are told that we cannot legally waive the co-payment? See them for free ? How can we force generations of patients who are used to the option of bulkbilling to suddenly always pay an amount? What about nursing home visits and how does this affect Veterans
  • What happens to the bulk billing incentive payment ?- that is currently worth $9.10 per consult
  • How does this affect the annual indexation of the Medicare Rebate  ?- as mentioned this has not been indexed since 2012.

Taking into consideration all of the above lets consider a few possible scenarios

(from best to worse):

The co-payment is on top of the current rebate and the Bulkbilling incentive stays put

GPs will have a have a massive increase in their income for bulk billed services in the first year – for a standard consult is is currently $36 (Vocationally Registered GP) or $21 (non-VR) plus the  incentive of $9.10. If the co-payment is added to this we get as much as $ 15 more per visit

The very strong assumption with this scenario is however that there will be no annual indexation of rebates for at least 3-4 years so the added benefit for GPs will very quickly level off – this however still remains the best scenario from the GPs perspective

The Co-payment is on top of the current rebate but we lose the incentive:

The only visit where the proposed co-payment is more than the existing bulkbilling incentive is the $15 for the first 15 non-concessional visits (and would not have qualified for the incentive anyway) – these patients however do not make up most of the GP visits so in practice GPs will actually face a reduction in their income for patients who have some sort of concession that rtiggered payment of the incentive

The co-payment makes out part of the rebate

This is the worst case scenario (and one I am cynically thinking may be very likely).

The current bulkbilling income for a standard VR consult is as mentioned around $45 for a patient on a concession card and $36 for a non concessional patient. Non – VR is would be $ 30 and $ 21 respectively

If the incentive remains in place the Government would save up to $ 15 per visit however if they get rid of the incentive they no longer have that expense AND save the money from the patient paying a co-payment.

a Significant drop in income to a bulkbilling clinic would be the end result

This will have a HUGE implication for practices who survive on rapid throughput bulkbilled consults – one can have a debate on the quality of the services these places provide but the fact of the matter is that there are people who cannot afford to go elsewhere and they will now HAVE to go elsewhere – until a fee at the Emergency Department closes all avenues for them

The fate of GP medicine in Australia is about to change and it is most likely going to be a very bad change for GPs – especially those of us who own our own Practices.

The final straw is off course the fact that most GPs would also fall in the income bracket that would puts them in line for most of the other proposals in the Commision of Audit – we will pay more for our Private insurance, more tax, work longer and have less concessions on our retirement savings

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4 Responses to The Co-payment debate – the GP aspect

  1. Edwin Kruys says:

    Good analysis. There is indeed a lack of information about how it’s all going to work. This year’s budget will be a game-changer for consumers & GPs.

  2. It’ll be interesting to see what the washup is in the Budget. I suspect the mooted $15 co-payment will not make it and the watered down $6 co-payment will. Is expecting $6 for a GP consult unreasonable? Price signals have worked with cigarettes and alcohol and petrol (unless you are completely cynical and believe they are revenue raisers for governments…), why would they not work with GP visits.

    I also note that people have made the point about Triage category 4 and 5 not being ‘GP type visits’. Someone recently counted the numbers in an ED and found 71% ‘ED type patients’ and 29% ‘GP type patients’. It was later said that patients are smart enough to present appropriately to ED or GP as they deem fit. Surely if patients are that smart, then they will be able to determine their need for an appropriate GP visit?

    We have a $22 million Health Direct phone service, GPs should be educating our patients, Medicare Locals have been generously funded, we have triage nurses at every ED, and we have the data above – is it time to let patients decide?

    • Thinus says:

      I expect you are right about the watered down $6 but that will be the least of our problems.

      The concessional patient may have a small amount out of pocket but as small businesses our bottomline may be affected if the actual rebate turn out to be a static or even reduced income in the long term

      The two-tiered system that will evolve from these recommendations will also be a nightmare. The Commission’s own explanation is that Private Insurers should be involved at the Primary level as it would assist them in planning better for the expenses at Secondary level. This implies that clinical information would be to the Insurers in return for their funding of the GP visit – this is the only way they could use the data to deal with the Hospital/Specialist expenses. I am well familiar with such a system – in South Africa all doctors have to add ICD10 codes to their bills and privacy/confidentiality is a joke.

      Lastly we should consider the impact on the “rich”. Each and every doctor would fall in this category as we all exceed $ 88,000 pa. If we do not take out the new Private Insurance mooted we could pay up to 3.5% extra tax (on top of the 1-2% deficit levy) but wait, there’s more – the Commission said the Insurers should charge higher premiums for lifestyle choices such as smoking. It did not take long for the boundaries to shift – today the NIB’s Chief Executive is quoted as stating that overweight people should pay more. How long before those with a family history of some sort of risks get hit with a loading.

      As a Consumer this is a big concern.

      • I think, our system works better than the American and the British systems. I don’t see why we are copying them. I also don’t think Private Insurance should cover primary care – that’s like claiming your servicing on your car insurance or your gardening and Maintainence on your house insurance. I would like to see some pretty savage spending cuts in other areas first.

        Also if private insurers are to cover primary care, and take family history into premium calculations, where will genetic testing play a part?

        Brave new world indeed.

        I favour a modest copayment, on top of the existing rebate, not applicable to those in receipt of income benefits, and no involvement of private insurance in any GP services. I don’t support any new tax. A dollar to the government is a dollar taken from the productive economy.

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