***Medicare Co-payment- brief explanation Medicare was established in 1984 and is Australias universal health insurance program.

Medicare is funded by a 1.5 income ta! levy and aims to remove financial barriers and allow e"ual access to health care services for all Australian residents# despite their socioeconomic status. $$$Although the ma%ority of &' services are funded by the government through Medicare# personal payments by individuals are an increasing trend and are commonly (nown as )out*of poc(et e!penditure. )'o*payment is the amount individuals pay for &' services after the Medicare subsidy or benefit from private health insurance has been deducted. +n most cases# people with private &' insurance incur an )out of poc(et e!penditure# or a )co*payment. ,he co*payment amount is dependent on the level of their cover. -hen the .harmaceutical benefits scheme was first introduced# Australians had access to medications )free of cost. &owever# there have been progressive modifications to ./0# most notably the increase in user co* payments. ,he ./0 also has a )safety net threshold to minimi1e the financial barriers to access medications and to provide some protection from high co*payments. 2or e.g. if a concession card holder re"uires more than 53 prescriptions per year# they can obtain a safety net card. ,his entitles them to further prescriptions without a co*payment. ,his idea could be transferred to 4. visits# providing a safety net for people with chronic illnesses who need to see their doctor on a regular basis. $$$,his discussion is on the li(ely effects of medicare co*payments on 4.s and their patients. ,here are currently many 4.s who charge more than the medicare subsidy# passing the gap onto the patient. ,here are also some 4.s who refuse to raise their consult fees and bul( bill their patients. ,here are benefits to both systems. 0ome patients cannot afford to pay the co*payment and would be happy to settle with shorter consult times and longer waiting lists. 5ther patients would rather pay the e!tra and get a longer consult time and shorter waiting lists. A universal system# with universal co*payments or universal bul( billing may not be the answer# as there are different re"uirements for different people# depending on their socioeconomic bac(ground and political views. ,he issues of e"uity and effectiveness of co*payments and general practice will now be discussed by /yron. ***Byron- equity and effectiveness

Katie- Efficiency ***There are numerous issues that make bulk billin system

an in-efficient

6fficiency is a term used by economists that refers to allocating resources in such a way as to ma!imi1e their utility. 7tility# or satisfaction# can be gained or lost from the consumption of goods or services. +n the case of general practice# if given a set budget# the most efficient system would deliver the best possible health outcomes for the population. $$$As mentioned earlier# the co*payment system e!ists in some general practices# and not in others. /ul( billing ma(es health care affordable for people from all socioeconomic bac(grounds# however there are numerous issues that ma(e bulk billin an in-efficient system. 'onversely# these same issues ma(e a Medicare co*payment system a more efficient system. !nefficiency of bulk billin system" issues that #ould support a medicare co-payment system ,hese include8 over*servicing8 people using the service even though they dont need to %ust because it is there and )free. si! minute medicine8 shorter consult times due to an overburdened system can cause problems such as8 o poor management of comple! medical problems8 ,his can result in long term problems for the patient and more costs for the government poor continuity of care 9 with long waiting lists due to an overburdened system# 4.s would have difficulty finding the time to follow up with patients. ,his could result in a less healthy population and thus reduce efficiency in the long term. e!cessive ordering of investigations 9 e.g. 4.s can order pathology lab tests even though it is not necessary# because they are )free. ,his is a waste of money and reduces efficiency of the &'0. o ,his idea lin(s in with corporate (ic(bac(s. 2or e.g. a pathology lab may give a doctor a reward :e.g. holiday or new car; for over* ordering pathology tests# and using their particular lab. corporate (ic(bac(s9 0ome 4.s dont feel as if the system allows them to ma(e any money without selling out. 2or e.g. a pharmaceutical company could reward a doctor if they sell a certain "uota of their product. Many doctors use corperate (ic(bac(s to subsidise their

income. ,his may be subsidi1ing the 4.s income# but it costs the government and thus reduces the &'0s efficiency. o ,his also costs the &'0 as overprescribing antibiotics has led to the current problem of antibiotic resistance All of these factors are relevant when discussing the in*efficiency of the overburdened bul( billing system. ,hese problems would be reduced in general practices that charge their patients an e!tra co*payment. &owever# the fact remains that there will always be patients who cannot afford to pay the co*payment or gap. ,hus a compulsory co-payment system for $%s #ould reduce efficiency in the following ways. ***The in-efficiency of a more expensive co-payment system for $%s patients will use the emergency room as a )free doctors office for ambulatory care patients will not go to the doctor when they are sic( as they can not afford it o the loss of wor( from an easily treatable illness would cost the government in welfare o the illness could also become worse and re"uire hospitali1ation which would cost the government a lot more than a 4. visit o not having regular )chec(*ups with a 4. would reduce the chance of detecting and preventing disease such as heart disease and diabetes this would be detrimental to the general health of the population from low socioeconomic bac(grounds thus proving ine"uitable and increasing financial burden on the &'0 in the long term +t is clear that there are many reasons for and against Medicare co* payments. ,he bul( billing system is clearly necessary as denying people health care who cannot afford it would result in a less healthy population and would put pressure on the &'0 in other departments and certainly in the long term. 'onversely# the bul( billing system is so overburdened that health care is less convenient for patients and consultations are often rushed. ***&cceptability" Co-payment system or not'

,here are two general publics in Australia to consider when discussing the acceptability of a co*payment 4. service. ,he first are those who support bul(*billing and oppose a compulsory Medicare co*payment system. ,his group generally cannot afford to pay e!tra to see their doctor. ,he second group is the wealthy# who are cash rich and time poor. ,hey would prefer to pay for the convenience of immediate health care and a more thorough consult. $$$.erhaps the ideal solution to most of the problems with the bul(*billing system is that doctors should be allowed to bul(*bill and charge a cash co* payment. ,his would (eep the transfer of money between Medicare and doctors simple and save a lot of money that is currently been wasted on administration. +t would also increase the amount of people willing to pay e!tra for a more convenient# longer visit# ta(ing the pressure of the public &'0. +t would give 4.s more of an opportunity to charge a fee that would allow them to devote more time to each patient. /y having some solely bul( billing doctors and some doctors who charge additional co*payments may be the best solution for Australia. ,his would give the people the option to choose# depending on their economic status and political views. ,his system could be thought of as a bipartisan approach to ambulatory &' :wal( in patients;# reflecting the political ideology of the half liberal# half labor population. $$$ "uestion time