GP co-payment proposal: lessons from the past

Parliament house flag post
Doctor checking blood pressure with sphygmomanometer

GP co-payment proposal: lessons from the past

Posted 30/04/2014 by Amanda Biggs

Recent comments by Health Minister Dutton and ongoing media speculation suggest the Government is considering a $6 patient co-payment on GP visits. Speculation is mainly focused on a proposal by former Coalition adviser, Terry Barnes, who describes his GP co-payment proposal as a revival of a 1991 Hawke Government measure.

The key features of the Barnes proposal are:

  • an indexation freeze on Medicare Benefit Schedule (MBS) fees for GP consultations until 2018
  • a co-payment of $6 for all GP attendances
  • a safety net for concessional patients and families with children after 12 visits a year: subsequent GP attendances in that year would be free
  • the removal of Extended Medicare Safety Net (EMSN) caps on GP services. GP co-payments would count towards the EMSN
  • allowing GPs to waive the co-payment and
  • allowing co-payments and expenses below the EMSN threshold to be covered by private health insurance.

The freezing of the MBS fees until 2018 is to encourage doctors to impose the co-payment, or suffer a financial loss.

To support these measures, Barnes also proposes reducing or removing regulatory and policy requirements to visit a GP to:

  • obtain a doctor’s certificate for minor ailments
  • obtain a specialist referral from a GP or
  • obtain a repeat prescription.

Savings from the Barnes proposal are estimated to be $749 million over the forward estimates.

1991 GP co-payment measure

In the 1991–92 Budget, the Hawke Government announced several measures to restrain growth of the MBS. From November 1991, the Medicare benefit to non-concessional patients for GP visits would be reduced by $3.50. From November 1992, there would be a further reduction in benefits for GP services to non-concessional patients of $1.50, taking the total reduction to $5.00, which would then be indexed annually. GPs would be allowed to charge non-concessional patients a co-payment of up to $3.50 on bulk billed services.

The Government also proposed expanding the Medicare safety net to include family expenditure, and allow gap payments for GP services to count towards the safety net, as well as a range of general practice reforms.

Savings of $1.6 billion over the forward estimates were forecast.

Following the announcement a fierce debate erupted within the Labor party over the co-payment proposals. A special Caucus Review Committee was established to recommend a way forward. A revised measure was subsequently agreed.

The revised measure retained the $3.50 reduction in the Medicare benefit for GP services for non-concessional patients, and the subsequent increase and indexation arrangements. But the amount of the GP co-payment for non-concessional patients was reduced to a maximum $2.50 (rather than the original $3.50). An additional $1 transaction fee would be paid to GPs to encourage them to continue to bulk bill.

Legislation to enact the proposal was passed, but the measure was short lived. New Prime Minister Keating abolished the GP co-payment and reduction in MBS benefits in March 1992. The safety net arrangements and GP reforms were retained.

The impact of the temporary co-payment on MBS growth is hard to gauge, partly because it involves such a short time period which is not easily captured by annual Medicare statistics. Unpublished Medicare data provided to the Parliamentary Library in 1992, indicates that over the period, some 6.2 million services were bulk billed, including 3.2 million services for concessional patients (who were exempt from the co-payment). Doctors declined to impose a co-payment on some 865,000 services, and just 1.8 million services attracted a co-payment.

Although the Barnes proposal is described as a revival of the Hawke Government measure, they are quite different proposals. For example, the Barnes proposal applies a co-payment to all GP services, not just those that are bulk billed, and it applies to both concessional and non-concessional patients. Some of the additional features also go well beyond the Hawke Government measures.

Interestingly, the Howard Government’s 2003–04 Budget included a proposal to allow GP’s to charge a patient ‘gap’ fee up-front to non-concessional patients, provided they agreed to bulk bill all concessional patients. The GP would claim the balance of the Medicare fee direct from Medicare. It was promoted as improving patient affordability and was not forecast to generate any savings. However, the legislation to enact the measure failed to pass.

Unlike the Hawke Government measure which exempted concession card holders from the co-payment, recent media speculation suggests that the proposal under current consideration would see all patients charged the $6 co-payment for a bulk billed visit.

Whether the Government proceeds with a co-payment proposal will not be known until budget night. The fate of similar measures in the past suggests a co-payment will be controversial and difficult to implement.


  • 8/06/2014 4:46 PM
    Jay said:

    It seems reasonable to have a modest GP Co-payment fee of $6, which will deter some of the unnecessary and avoidable visits o the medical centers. Although I believe that there should not be any hindrance or barriers for the public to visit their GP and by doing so, we may create one. I feel that there are many instances and particularly to certain communities patient report to their GP’s late. This may apply to aboriginal people and patients with mental health. If there is a little delay of even few days can increase in ED visits, which will have a worse outcome in terms of patient care and eventually cost implications. If just by declaring that this may start next year there are GP practices, which are already affected resulting in increase in ED presentations. There is a fierce debate going on in the parliament at this stage and I would be very concerned if the government finally goes ahead with this proposal.

Thank you for your comment. If it does not require moderation, it will appear shortly.
Facebook LinkedIn Twitter Add | Email Print


Flagpost is a blog on current issues of interest to members of the Australian Parliament

Parliamentary Library Logo showing Information Analysis & Advice




refugees asylum immigration Australian foreign policy Parliament climate change elections women social security Indigenous Australians Australian Bureau of Statistics Employment taxation Sport illicit drugs Medicare welfare reform Australian Defence Force welfare policy Asia income management Middle East criminal law disability Australian Sports Anti-Doping Agency World Anti-Doping Agency United States higher education people trafficking school education aid statistics Australian Electoral Commission WADA United Nations federal budget health financing emissions trading gambling Australia in the Asian Century steroids detention Private health insurance OECD ASADA labour force transport Law Enforcement Australian Federal Police Industrial Relations dental health National Disability Insurance Scheme forced labour Senate election results Papua New Guinea Australian Public Service International Women's Day corruption Fair Work Act child protection people smuggling debt federal election 2013 parliamentary procedure ALP New Zealand Australian Crime Commission Newstart Parenting Payment 43rd Parliament slavery by-election political parties Census constitution High Court skilled migration voting Federal Court terrorist groups Afghanistan Higher Education Loan Program HECS youth Aviation environment foreign debt gross debt net debt defence capability customs poker machines doping health crime health risks multiculturalism aged care Gonski Review of Funding for Schooling sex slavery sea farers leadership United Kingdom UK Parliament Electoral reform politics banking firearms public policy mental health China ADRV terrorism social media pensions welfare ASIO intelligence community Australian Security Intelligence Organisation governance public service reform Carbon Pricing Mechanism carbon tax mining military history employer employee fishing paid parental leave European Union same sex relationships international relations coal seam gas planning United Nations Security Council Australian economy food vocational education and training Drugs Indonesia children codes of conduct terrorist financing election timetable citizenship Productivity asylum seekers early childhood education Canada Population Financial sector national security fuel violence against women domestic violence disability employment Tasmania integrity science research and development Australian Secret Intelligence Service sexual abuse federal state relations World Trade Organization Australia accountability housing affordability bulk billing water renewable energy children's health health policy Governor-General US economy export liquefied natural gas foreign bribery question time speaker superannuation family assistance expertise Senators and Members climate Intergovernmental Panel on Climate Change Department of Agriculture Fisheries and Forestry food labelling Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets health reform Indigenous constitutional recognition of local government local government consumer laws PISA royal commission US politics language education Leaders of the Opposition Parliamentary remuneration health system Australia Greens money laundering servitude Special Rapporteur Trafficking Protocol energy forced marriage rural and regional Northern Territory Emergency Response ministries social citizenship China; Economic policy; Southeast Asia; Africa housing Speaker; House of Representatives; Parliament Defence High Court; Indigenous; Indigenous Australians; Native Title ACT Indigenous education Norfolk Island External Territories emissions reduction fund; climate change child care funding refugees immigration asylum procurement Indigenous health e-voting internet voting nsw state elections 44th Parliament 2015 ABS Age Pension Death penalty capital punishment execution Bali nine Bali bombings Trade EU China soft power education Fiji India Disability Support Pension Antarctica Diplomacy by-elections state and territories workers Bills anti-corruption fraud bribery transparency corporate ownership whistleblower G20 economic reform innovation standards NATO Members of Parliament Scottish referendum Middle East; national security; terrorism social services Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 online grooming sexual assault of minors ACT Assembly public health smoking plain packaging tobacco cigarettes Asia; Japan; international relations Work Health and Safety Migration; asylum seekers; regional processing China; United States; international relations fiscal policy Racial Discrimination Act; social policy; human rights; indigenous Australians Foreign policy Southeast Asia Israel Palestine regional unemployment asylum refugees immigration political finance donations foreign aid Economics efficiency human rights; Racial Discrimination Act employment law bullying Animal law; food copyright Australian Law Reform Commission industry peace keeping contracts workplace policies trade unions same-sex marriage disorderly conduct retirement Parliament House standing orders public housing prime ministers sitting days First speech defence budget submarines Somalia GDP forestry world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission regulation limitation period universities Ireland cancer gene patents genetic testing suspension of standing and sessional orders animal health live exports welfare systems infant mortality middle class welfare honorary citizen railways disciplinary tribunals standard of proof World Health Organisation arts international students skilled graduate visas temporary employment visas apologies roads Italy national heritage NHMRC nutrition anti-dumping Constitutional reform referendum Rent Assistance competition policy pharmaceutical benefits scheme obesity evidence law sacrament of confession US presidential election international days baby bonus DFAT UN General Assembly deregulation Regulation Impact Statements administrative law small business Breaker Morant homelessness regional engagement social determinants of health abortion Youth Allowance Members suspension citizen engagement policymaking federal election 2010 workplace health and safety Trafficking in Persons Report marine reserves hearing TAFE Victoria astronomy resources sector YMCA youth parliament alcohol Korea rebate Australian Greens presidential nomination Racial Discrimination Act entitlements political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing Hung Parliament political education social inclusion Social Inclusion Board maritime early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin Iran sanctions

Show all
Show less
Back to top