Dr Nick Tellis – my personal view on Budget 2014.

Joe Hockey must be wishing he could see a GP right now. Stressed? Tired? Not feeling your best? From a quick glance at the media this week, online and off, the Budget seems to have upset almost everyone. What does it mean for GPs? It seems that there will be a co-payment of $7, applied to a Medicare rebate fee $5 less than the current $36.30 (for a level B consult). If the co-payment is applied, it will mean $2 extra to the GP, $7 extra from the patient (all patients, not just those formerly bulk billed), and will attract a ‘Low Gap Incentive’ for the GP (probably equal to the current 10990 or 10991 bulk billing incentive – but it’s, like many of the details, unclear). If it isn’t, it’ll be no change to the formerly bulk billed patient, but $5-$14.10 less for the GP (as the bulk billing incentive/’Low Gap Incentive’) will not apply. For those on concession cards or under 16, the co-payment will be capped at 10 services ($70/year).

$70 a year. It’s not very much, but obviously the Government thinks it will be, and patients think it will be, enough to dissuade people from seeking medical care. Others have debated this in detail – talking about patients ceasing their medications (as they apparently did in 2005 when the PBS co-pay went up), presenting to emergency departments instead, and avoiding medical care altogether. I’d like to take a different look at things.

All free services are undervalued. That’s just the way things are. If you get something for free, you don’t appreciate it’s value. Plastic bags, the tragedy of the commons, public toilets…putting a price on things increases their perceived and real value. No GP will raise their hand and say they haven’t seen some patients for bulk billed appointments that were completely unnecessary. The snotty nose, the monthly benzodiazepine prescription, the authority prescription, the specialist referral letter, the hospital referral letter, the squeezed in child (because they’re here, doctor)…all costing other people money. There is no community support for the removal of the ridiculous PBS authority line because the patients do not bear the cost.

So this is the beginning of price signals for a large cohort of patients. In theory, I think this is good – people need to know there is a cost to services, they need to value what they get, and they cannot have endless access to other people’s money. In reality, there will be a lot of churn – where money is taken from taxpayers, cycled through paid public servants, doled out to welfare recipients, and then back to doctors. There will be logistical problems – it was previously illegal to bulk bill with a gap, how do I know how many services the patient has had? There will be people who miss out on medical care or medications. It will happen.

But think about this.

Is it right that some citizens should have an unchecked ability to spend other people’s money?

Should someone on the poverty line ($503.71 per week) be paying tax to subsidize a free visit to the GP for a person earning $150000/yr?

The co-payment does NOT apply to Chronic Disease Items. You can see your GP, if you have a chronic disease, 9 times a year, with 5 visits to the nurse, and 5 visits to allied health, all under Medicare, with NO co-payments (721, 723, 732 x 6, 10997 x 5, 2517, allied health 5 visits).

There are NO co-payments on Mental Health item numbers (2713, 2712, 2715).

It will now become cheaper for the patient to demand quality time from their GP rather than the mythical ‘everything tests’ of CTs for back pain and blood tests for everything else (I suspect the pathology labs will absorb the co-payment costs to be honest).

We shall see. It won’t change the way I practice – my private patients will still get a gap, and those I feel the need to discount my fee for will still be discounted. If they can’t pay $7, so be it. It may be that the Senate shoots the whole thing down in flames anyway… I look forward to your comments – fire away!