WHY CO-PAYMENTS ARE NOT ALL GOOD

In celebrating the one-year survival of the Abbott government former prime minister John Howard was reported to have asked why, if we have co-payments on pharmaceuticals, we should not have one on general practice. Five reasons stand out.  

First, the co-pays on prescription drugs stop poorer people from accessing to them. Ask general practitioners. Extending co-pays to general practice compounds rather than solves this problem.  

Second, seeing a doctor for a health worry is different to filling a script. A consultation with a doctor may dissipate the worry without further cost or action.

Third, a timely, uninhibited consultation for the first symptom – chest pain, let’s say – of a serious problem may save a life and nip the progress of a disabling illness. Co-payments diminish easy access for less affluent Australians to general practice

Fourth, a consultation may lead to preventive changes – quitting smoking, behaviour modification, stopping unnecessary medications – that are positive investments, not sunk costs.  Co-pays that inhibit preventive consultations diminish the chance of a healthy life.

Fifth, many general practitioners in poorer parts of the country who entirely bulk-bill do not have the financial systems to raise fees.  The logistics of collecting and remitting a co-payment could drive them out of business.

Maybe the co-pays on pharmaceuticals are a public policy error that permits gouging of pharmaceutical prices and diminishes the search for efficiency in drug supply. Rather than asking where else we can impose a co-payment, the question should be, “We don’t have co-payments on general practitioner bulk-billed consultations, so why should we have them on prescribed pharmaceuticals?’

By way of postscript, the current debate about how much the Medicare levy contributes to health care costs is informed by figures from the federal minister that are all wrong.