The Minister for Health Peter Dutton has proposed that people visiting GP should no longer be bulk-billed but should make a payment of $6 to the GP. “We have a discussion about you or me on reasonable incomes, whether we should expect to pay nothing when we go to see the doctor.”
On the surface this appears to be a reasonable argument. But there are always flow on effects from policies like this. Doctors and academics have been quick to condemn the move saying it will deter people from seeing the doctor, particularly those for whom $6 is a lot of money. The flow on argument is shown in the causal loop diagram below. The co-payment either deters people from attending the GP or redirects them to the emergency wards.
This sets up a vicious cycle.
The extra attendance at emergency increases the number of people being given a hospital bed and this increases the availability of beds in hospitals and leads to a increasing delays in elective surgery. The effect of this is that people either visit the GPs more or present to the emergency wards and the circle continues.
The number of people being admitted to hospital may not be particularly great but this is on a system that is already stretched to the limit and anything that increases the number of people presenting in emergency wards has the potential to have significant knock-on effects through the whole system.
Certainly, one consequence of increased presentations in emergency will be increases in the use of ramping and major hospitals going on emergency bypass. Both of these techniques are designed to hold emergency patients until camps available for them in the emergency ward.
In effect, it delays the admission of these patients into the emergency ward and extends the number and the period of time that the emergency ward will be admitting patients to the hospital. The dynamics of this are shown in the causal loop diagram below where the new dynamic is shown in the two small black loops.
One thing the Minister has not yet explained is how the $6 fee will be used.
Will it simply be used to top up GP’s income?
Will it be used to reduce the Medicare payment to GPs by $6?
What happens for those of us who already pay a $30 co-payment?
Will we now pay $6?
Dutton is right. It probably is time to have a conversation about how we can ensure good medical treatment for the entire population. It would probably help if he were to explain a little bit more about where money is going.