It’s no secret that the government wants to cut the health budget. The Commission of Audit report, published in early 2014 argued that current expenditure on health was not sustainable without reform and recommended co-payments as high as $15 for general patients, and $7.50 for concession card holders. The rationale behind this, the report states, is the need for ‘the community to become more aware of the real costs of health care’. Oddly enough, this expensive consciousness raising exercise for patients is also supposed to achieve ‘more deregulated and competitive markets’. Behind it all is an aspiration for ‘competitiveness and productivity’, buzzwords now so depleted of any meaning beyond being synonymous with the public paying more so that government-run services can be made profitable for private service providers.
In April 2013, former Health Minister Peter Dutton continued to call for for cutting the Medicare budget based on the report’s claim that current spending is not sustainable into the future. The neoliberal’s dream budget arrived in May 2014, brimming with an array of cost-shifting measures including a concrete policy manifestation of the infamous ‘GP co-payment’. Public outrage and its rejection by the professional body that represents doctors saw the policy dropped. Then a quiet ministerial reshuffle.
After that came the reviews. Six of them under the current Health Minister Sussan Ley, and a raft of proposed changes for primary health care, medicare rebates, prescription medicines, health insurance, mental health and electronic health records. The proposed changes are significant. For many medical conditions, and in particular chronic ones, medical practices could be allocated a yearly budget instead of doctors receiving payment per patient treated.
Of particular concern are measures that would seek to link funding to patient health outcomes (like hospital admissions, or reductions in blood pressure and blood sugar levels), under the pretext of measuring a doctor’s ‘performance’. Linking unsatisfactory measurements for particular patient health indicators to funding levels could have dire and unforeseen consequences for both patients and doctors. In the UK, years of ‘efficiency savings’ and performance-based budgeting have brought the public health system to the brink of collapse.
Equally baffling among the government’s plans is the proposal for a new category of health care workers known as ‘care co-ordinators’, who would be paid to help patients navigate this new system. But we are yet to see any evidence that diverting funds from the health budget to recruit service providers into a managerial intermediary role would improve health outcomes for patients or make doctors’ workloads more manageable.
If the proposed measures are implemented, patients could also end up out of pocket for everything from blood tests to X-rays and CT scans to pap smears. The reaction from the public and from professionals in the field has been one of swift condemnation, with a number of petitions now circulating against these changes (you can sign them here and here).
On the question of billing for pap smear charges Sussan Ley’s office has been quick to respond, stating that ‘alleged claims by pathologists about the potential cost of raising their prices as a result of any changes are also misleading.’ The press release goes on to state that ‘Medicare is not designed to be a guaranteed bankable revenue for corporations, nor is a tax-payer funded payment like this provided to cross-subsidise other costs of doing business for pathology companies.’
That is all good and well, but let’s remember that the costs covered by Medicare are designed to pay for the pathology services on behalf of the patient. If pathology companies decide to pass funding cuts on to patients as an extra charge, then the government will have successfully shifted a portion of pathology costs onto the public.
If this sounds confusing it is because each of the government’s attempts to set the record straight has only pushed the real issue further out of view. Confusion is the name of the game when you want to sell people something they don’t need, and that they don’t like.
The signs were there well before the 2014 budget. Sociologist and social policy researcher Shaun Wilson warned that the introduction of a co-payment would have flow-on effects well into the future and could spell the unravelling of the Medicare system as we know it. He wrote:
“Compulsory co-payments are about the long-term: breaking down public solidarity about a scheme that Australians associate with providing something for free and something for everyone.”
Health professionals also reacted with concern about the prospect of passing on more medical costs to patients, already high by world standards, and the potential for important health diagnoses to be delayed as a result. Anne-marie Boxall, Director of the Deeble Institute for Health Policy Research and Adjunct Lecturer at the University of Sydney, cautioned that a co-payment could “reduce necessary GP visits” and “be an unfair burden on people with lower incomes”.
The latest round of proposed changes might sound a little different, but the underlying principle is the same: get people used to the idea of paying for services. The President of the Australian Medical Association, Professor Brian Owler summed it up when speaking against these latest changes, referring to them as “a co-payment by stealth”.
The current government seems set on the idea of making people pay more for their health costs on the one hand, while proposing a range of policies that would undermine GP autonomy in decision-making on the other. It is difficult to see how either patients or doctors would benefit from this arrangement.
But this is the logic of market-oriented policies. They demand that public health, welfare and education be run like corporate enterprises, or be sold off to for-profit providers. They undermine trust in public services by linking funding to categories like efficiency, productivity and performance, in other words, categories designed to measure how much a public service runs like a corporation. But this was never what public institutions were supposed to be, nor is it something we should let them become.