Co-payments for health care: what is their real cost?

Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by individuals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system.

[1]  P. Arnold.  Copayments for general practice visits , 2014, The Medical journal of Australia.

[2]  C. Mar.  Copayments for general practice visits , 2014 .

[3]  K. Houlberg,et al.  How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011 , 2014, The European Journal of Health Economics.

[4]  K. Sikaris.  Liaise with pathologists to refine understanding of the prostate‐specific antigen test , 2014, The Medical journal of Australia.

[5]  C. Schoen,et al.  Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. , 2013, Health affairs.

[6]  S. Leeder,et al.  Can't escape it: the out‐of‐pocket cost of health care in Australia , 2013, The Medical journal of Australia.

[7]  James A. Gillespie,et al.  Living with economic hardship at the end of life , 2013, BMJ Supportive & Palliative Care.

[8]  Claire Buckley,et al.  The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis , 2013, PloS one.

[9]  I. McRae,et al.  Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions. , 2013, Australian journal of primary health.

[10]  E. Roughead,et al.  From the city to the bush: increases in patient co-payments for medicines have impacted on medicine use across Australia. , 2013, Australian health review : a publication of the Australian Hospital Association.

[11]  J. Chapman,et al.  How are patients managing with the costs of care for chronic kidney disease in Australia? A cross-sectional study , 2013, BMC Nephrology.

[12]  S. Jan,et al.  How Are Household Economic Circumstances Affected After a Stroke? The Psychosocial Outcomes In StrokE (POISE) Study , 2012, Stroke.

[13]  T. Usherwood.  Private specialist practice: the forgotten sector in health care reform , 2012, The Medical journal of Australia.

[14]  S. Leeder,et al.  Falling through the cracks: the hidden economic burden of chronic illness and disability on Australian households , 2011, The Medical journal of Australia.

[15]  S. Leeder,et al.  We can't afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia , 2011, Journal of health services research & policy.

[16]  R. Viney,et al.  Extended Medicare Safety Net review of capping arrangements report 2011: a report by the Centre for Health Economics Research and Evaluation , 2011 .

[17]  Perceptions of economic hardship and implications for illness management: a survey of general practitioners in western Sydney , 2011 .

[18]  M Alan Brookhart,et al.  The Epidemiology of Prescriptions Abandoned at the Pharmacy , 2010, Annals of Internal Medicine.

[19]  S. Chambers,et al.  Fuel, beds, meals and meds: Out-of-pocket expenses for patients with cancer in rural Queensland , 2009 .

[20]  D. Remler,et al.  Cost-sharing: a blunt instrument. , 2009, Annual review of public health.

[21]  Max Bulsara,et al.  The impact of co‐payment increases on dispensings of government‐subsidised medicines in Australia , 2008, Pharmacoepidemiology and drug safety.

[22]  Á. Benedict,et al.  The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review , 2008, International journal of clinical practice.

[23]  A. Oxman,et al.  Pharmaceutical policies: effects of cap and co-payment on rational drug use. , 2008, The Cochrane database of systematic reviews.

[24]  Jon Emery,et al.  Guidelines for preventive activities in general practice. , 2001, Australian family physician.