The following is a comment to the online article, “GP co-payments? Don’t save on primary care” written by GP blogger, Dr Edwin Kruys.
Great article. I agree with your premise.
Regarding individuals valuing the services they receive from the GP more with co-payment, we should recognise that this is a complex question. We should recognise that many GPs already privately bill.
The co-pay places a barrier to patients seeking health care. In a sense, it does ask patients to be more mindful of the care they seek to receive. We are asking patients to make a decision on whether their perception of the health problem is of greater value than the cost of the co-pay (in addition to all the other intrinsic barriers to seeking health care).
However, this financial barrier is regressive – it is likely to be irrelevant to someone who has a higher income and are relatively well. We know this from experience – practices in high income postcodes tend to have the highest private billing fees. In an area like the lower North Shore of Sydney, this is the case even though there is absolutely no shortage of GPs.
On the other hand, people who are sick or of low income, the co-pay represents a much greater barrier. The assumption that individuals will necessarily prioritise their longer term health over other immediate concerns is clearly false. Creating a system that implicitly turns health seeking into a moral virtue (i.e., a co-pay will make patients more “responsible”) is ideologically driven and unhelpful. We should be much more concerned with a health system that delivers patient meaningful outcomes.
At local practice levels, it may be that private billing and/or co-payment might be good solutions. It is almost certainly not going to be case if we apply this universally.