Coalition considers end to free GP visits

Doctors have criticised a proposal to charge a fee for every GP visit, saying it risked placing greater pressure on public hospitals.

The Abbott government is refusing to rule out a $6 fee for GP visits in a bid to rein in health spending, sparking fears that it will ultimately end Medicare and affordable healthcare.

The proposal would save the government $750 million over a four-year period by forcing patients who are presently bulk-billed to make so-called co-payments.

The Australian Centre for Health Research, a conservative think tank, argued for a resurrection of the co-payment scheme in a submission to the Commission of Audit, set up by the government to find big budget savings.

Australian Medical Association president Steve Hambleton said on Monday any change which would deter people from seeing a doctor would lead to more people using ambulances and presenting at hospital emergency departments when their health problems got more serious.

''I think we've got to identify what the problem is that we're trying to solve,'' Dr Hambleton said.

Dr Hambleton said if the federal government wanted to address rising health costs, it needed to better treat chronic disease to keep people out of hospital.

But he said making people pay more for GP visits would divert them from the ''efficient end'' of the system, general practice, to the ''expensive end'' of hospital care.

Dr Hambleton said the vast majority of GP visits were for legitimate purposes and introducing a fee to see the GP was the wrong way to address the problem of a small proportion of patients and doctors doing the wrong thing.

On Sunday federal Health Minister Peter Dutton refused to end speculation that the proposal had the government's support, only saying he was committed to ensuring the health system was ''sustainable and accessible to the future''.

"We won't be commenting on speculation around what the Commission of Audit may or may not recommend," Mr Dutton said in a statement.

Initial reports at the weekend suggested the co-payment should be $5 and families would be allowed up to 12 bulk-billed visits before having to pay the fee.

However, the report, obtained by Fairfax Media, shows the recommended co-payment is $6 and patients will not get 12 free visits a year. Instead, once they visit their GP more than 12 times in a year the government will start to pay the fee for them. It also says GPs may use their discretion to waive the co-payment on compassionate or financial grounds.

The report predicts that the volume of GP services would decline by 3 per cent a year if co-payment was introduced, slowing the growth in Medicare Benefits Schedule outlays from July 2014.

It would offer "a simple yet powerful reminder that, as far as possible, we have a responsibility to look after our own health, not simply pass on all the costs of, and the responsibility for, caring for ourselves to fellow taxpayers," the report says.

An architect of the Medicare system, John Deeble, said on Sunday that he did not support a $6 co-payment. "I don't support it because there would be some people whose minds would be changed who should actually be bulk-billed," Dr Deeble said. ''This is just fiddling with Medicare."

Doctors and health groups were quick to criticise the proposal on Sunday, claiming it would eventually destroy Medicare and make healthcare more expensive.

Con Costa, the president of the Doctors Reform Society, said it would be "the beginning of the end for Medicare".

But the author of the report, Terry Barnes - a former health adviser to Tony Abbott - said it was not intended to be a ''thin edge of the wedge case''.

''It's a modest and affordable solution to allowing access to a world-class general practice system,'' Mr Barnes said.

The opposition spokeswoman on health, Catherine King, said the Prime Minister needed to rule out any new fee immediately.

"Australians should not be provided a disincentive to visit their doctor," she said. "I am concerned about what additional pressure the introduction of a new 'GP tax' will have on an already struggling public hospital system, and what it will mean for families already struggling with cost-of-living pressures."

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