Proposal to give patients more say in what they pay their GPs

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Four in 10 Australians believe that patients should be able to determine how much they pay for a GP visit.

What’s more, patients would be willing to make voluntary out-of-pocket payments of $25 in return for shorter waiting times and longer consultations.

A Monash University study that tested a ‘Patient-Chosen Gap Payment’ (PCGP) model found that 39 per cent of the 1457 Australians surveyed would prefer to set their own out-of-pocket payment than to be bulk-billed or pay the compulsory gap that many GPs currently charge.

The model allowed patients to choose to pay any amount for their GP consultation, from nothing to, potentially, much more than the average out-of-pocket ‘gap’ payment.

In 2018/19, more than 85 per cent of GP visits were bulk-billed and the average gap payment for visits that were not bulk-billed was $38.46.

Monash University Associate Professor Duncan Mortimer said that the proposed scheme does not mean GPs would see patients for free, with the doctor continuing to receive the Medicare rebate for each patient.

“Our results suggest that patient-chosen prices for primary care could generate an extra $1.48bn in revenue, while also incentivising patient-centred care, without the need for complex outcomes-based funding formulas,” Assoc. Prof. Mortimer said.

“This line of research has the potential to reinvigorate debate around the delivery and funding of primary care in Australia, and in other countries with fee-for-service primary care, such as France, New Zealand and the US.

“We hope to undertake further research to understand how GPs would behave under PCGP pricing.

“What we can say is PCGP services are acceptable to patients and may offer a viable alternative pricing model in the market from primary care services.

“However, PCGP services must be delivered at high quality and with careful design if they are to capture market share and increase out-of-pocket contributions.”

While GPs can currently bulk-bill patients and accept the Medicare rebate as full payment for their services, the researchers explain that GP groups have long argued that the rebate is not enough to cover costs.

Research co-author and general practitioner Dr Daniel Epstein believes the PCGP model could provide a happy medium between compulsory out-of-pocket payments and bulk billing.

“Patients’ willingness to make voluntary contributions may come as a surprise,” Dr Epstein said. “Our research found, given the choice, women in more affluent areas were more willing to pay a little extra, while men in disadvantaged areas were more likely to stick with bulk-billed services.”

Researchers say if GPs respond to the PCGP model by taking a more proactive approach to managing their patients’ health, then costs could decrease – helping to limit further increases in private health insurance premiums.

Would you like the opportunity to pay what you wanted for GP services? Would you be willing to pay more for a longer consultation?

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Written by Ben


Total Comments: 32
  1. 0

    Totally irrelevant idea! As a pensioner whose GP and x-ray costs are completely bulk-billed, specialist fees either reduced or bulk-billed and hospital completely covered by private insurance, unless you’re talking about abolishing health fund subscriptions, things are ok as they are.

  2. 0

    Getting rid of medicare is not a solution.

  3. 0

    I rather novel idea. It must have been thought up by a lesser academic. Choose what you pay, if anything, are you kidding. And 85% of all visits to the doctors were bulk billed. Hold on, I think I hear Santa Claus coming down the chimney. What a load of rubbish. It’s increasingly harder day by day to find doctors that do bulk bill. 85% yeah sure. If you’re going to tell a porky, make it believable. A simply ludicrous idea. Regards Jacka.

  4. 0

    P.S. Oh yeah, and people want to pay more for shorter waiting times and longer consultations, isn’t that somewhat of a contradiction of terms. Jacka.

  5. 0

    What a stupid idea!
    It actually means access to a GP would be easier for the rich who can afford to pay more.

  6. 0

    This seems like a cover for going toward the American system which while being world class for those who can afford it is disastrous for those who cannot.

  7. 0

    I’d like to know how the “more than 85%” of patients were bulk billed figure was arrived at. I have a good friend living in a Sydney suburb who gets bulk-billed but she has no appointment for this service and can be sitting waiting long times depending on how many others are in the queue. Where I live in a country town there is one bulk billing doctor and the same applies – no appointment and a long queue. The rest of the doctors have notices on their front entrances indicated “This Is Not A Bulk Billing Practice’. I am a single age pensioner with no other sources of income. I get charged $68 per visit and receive $38.75 rebate from Medicare. My annual check-up and health assessment is bulk billed. If I have to see the nurse for blood pressure checks and/or dressings or other minor assistance her services are bulk billed. More than 20 years ago when I live in Sydney’s suburbs I was bulk billed without queueing but since moving to country NSW 20 years ago my bulk billing visits are few and far between. Sometimes if the dr is feeling generous he bulk bills me for filling out my medical details in order to obtain my driving licence but sometimes he charges. In January each year my fee goes up by $2 and of course the Medicare rebate is not as good as it was years ago. So this “think tank” idea can stay in the tank as far as I am concerned. The sample of people who thought it was a good idea was pretty small.

    • 0

      Same here Mitzy. I am in a Qld capital city outer suburb. I have been seeing my GP for over 18 years. The practice only bulk bills for locum doctors. To see my own doctor, I have to pay $89, get back $37, even though I am now on the Aged Pension.
      Last year I was not feeling well, and rang for an appointment. I insisted on seeing my own doctor – and thank heavens I did. She took one look at me and said ‘you don’t look your normal happy healthy self’ and immediately sent me for checks. Within half an hour I was being sent by ambulance to my local hospital with a pulmonary embolism, my condition critical.
      Had I chosen to be bulk billed, and not seen my regular doctor, there may have easily been a different outcome as he wouldn’t have had a clue about what was ‘normal’ for me. There is only one place that bulk bills, and doctor turn over is high. To stick with my regular doctor who KNOWS me (and another extreme condition I have), bulk billing is out of the question.

  8. 0

    Its doing nothing more than commoditising health service much like “pay what you think the meal is worth”.

    In these restaurants people frequently pay more than they would have done from a menu price not because the menu price may have been undercharged, but because the diner didn’t want to be considered ‘cheap’. The amount paid was no reflection of the meal or the service received.

    And don’t forget there was a condition of payment here. The service had to provide “shorter waiting times and longer consultations.” I really can’t see this idea taking off given that people could pay nothing yet demand more service. Doctors are not going to fall for that!

  9. 0

    We are fortunate here on the mid north coast of NSW in having a medical practice that bulk bills, at least for us pensioners. Our doctor is very patient and doesn’t try to hurry us out of his room, but listens to us.

  10. 0

    My GP bulk bills but does charges nearly$40 gap for anyone not on Centrelink. You should see the gap for an out of hours consult. We only have 1 clinic and the doctors are contracted by govt to supply after hours service. What hurts is when you go to as specialist. I have paid just over $200 gap which is getting closer to half my pension. A private hospital can charges upto $500 to come in through emergency.
    I think increase the Medicare rebate for go,s and bring down the gap for ALL specialists and makes them charge the same gap as reach other and if they want to bulk bill then give them a bigger Medicare rebate.
    The other thing is not to use trained people’s to make the these sort of decisions. It seems to me the more qualification people have the worse the decisions they make.

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