Health care

Cancerous co-payment
How not to fix the health care system

General practitioners are not often portrayed as the heroes of our public health system, but they save lives every day. I’m not a GP. I’m training to become a specialist obstetrician & gynaecologist and I work in a tertiary hospital. Every shift I’m reminded by my patients of the importance of quality primary health care.

Take Carrie. She’s a mother of three teenagers and she has cervical cancer. Her hospital visits are more frequent now. At first there were the specialist visits and biopsies, and then the chest X-rays, CT scans, MRIs. After that came the chemo-radiotherapy, the complications, the multiple admissions and the counselling. One of her kids dropped out of school to look after her. The younger two are having a hard time focusing on their studies and they’re not doing so well.

Cervical cancer is now largely preventable. PAP smears, which detect and prevent pre-cancer, are generally performed by GPs. So are breast checks, diabetes screens and prostate exams. There’s a good chance the quality of Carrie’s life would have been different had she been encouraged to see a GP regularly.

But GPs don’t just save lives. They also save us money. Carrie’s situation costs our health care system a significant amount. The impact this has had on her kids will cost us more again. The aim of our health care policies ought to be to avoid these situations, for economic as well as human benefit.

Contrary to the government’s current propaganda, Australia has, for the most part, a very efficient health care system. We spend 9.1% of our GDP on health care, which is less than most other OECD countries and around half that of the US. This percentage has increased over the last ten years, but only very modestly, and far less than those of other OECD countries. We get value for money, too. Our life expectancy is one of the highest in the world. And, just for the record, Australia has the lowest rate of cervical cancer worldwide. Far from suffering from a spending crisis, our health budget is in fact the envy of half the planet.

The system's biggest problem is actually in the hospitals, where patients whose conditions haven't been managed effectively too often end up queueing for beds. The best treatment is always prevention and, failing that, containment. GPs provide the bulk of preventative medicine and manage the majority of chronic diseases. They vaccinate children, treat diabetes, manage heart disease and provide pregnancy care. But they’re the lowest paid, least revered doctors in our health care system, and many are already charging co-payments to their clients who can afford it, just to keep their practices viable. Yet, they are in every sense, the gatekeepers to our more expensive secondary and tertiary hospital systems.

The co-payment as it stands will deter many – and not just the most vulnerable – from seeking the right care at the right time. Those it doesn’t deter it will divert: from the (Commonwealth-funded) GP offices to the (state-funded) expensive public emergency departments. More patients will come to the ED for scripts, certificates, cuts and colds. Those with poorly controlled chronic diseases will need admissions and acute care. Seven dollars will become $70 or $7000. We might finally get some money spent on scientific research through the government's proposed Medical Research Fund, but our health care system will be pushed to the brink.

The Australian Medical Association, patient advocate groups, the Greens and Labor all oppose the Abbott government’s proposed GP co-payment. Even Clive Palmer, who will ultimately determine the proposal’s fate, says he won’t agree to “a co-payment of even one cent”. In Palmer’s words, “the co-payment is dead”, and Health Minister Peter Dutton last week put it on hold. Yet Dutton has also insinuated that Palmer United may be less emphatic behind closed doors.

Of course, Palmer now has a track record of backflipping on “never ever” declarations when he’s able to negotiate a deal that favours his own interests. Palmer has stopped short of declaring himself, à la Abbott, a champion of the vulnerable. He is, primarily and unashamedly, a businessman. But the GP co-payment will have many knock-on effects. The government appears to have neither considered nor costed them. If nothing else, then, Palmer should recognise that the co-payment will not simply affect the vulnerable disproportionately; it will threaten the cost efficiency of the whole health system.

Nicole Krzys

Nicole Krzys is a Registrar in Obstetrics and Gynaecology. She also has a master’s degree in philosophy. When she's not delivering babies she ponders over politics, gender issues and the meaning of life.

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