Terry Barnes, who wrote the controversial submission advocating an end to free doctor visits for bulk-billed patients, said a similar fee should apply to emergency departments to stop patients abandoning GP services.

“To keep access fair and equitable, but also to ensure that resources are managed properly, the states could charge a matching co-payment for GP-type services in emergency departments,” Mr Barnes, a former health adviser to Tony Abbott, told Fairfax Media on Monday.

“I don't see why emergency departments couldn't charge a matching co-payment for those types of services.”

In a submission to the federal government's Commission of Audit, Mr Barnes wrote that the government would save $750 million by forcing patients who are bulk-billed to pay $6 to visit their GP.

The paper for the Australian Centre for Health Research says if patients pay a fee for their first 12 GP visits in a 12-month period, then the government will save $750 million over four years.

Doctors and health groups have criticised the idea, saying patients will try to avoid the fee by using hospital emergency departments instead.

Federal Minister for Health Peter Dutton refused again to end speculation that the Abbott government supported co-payments.

Media were referred to a statement he released on Sunday, saying the Abbott government was committed to making sure Australia's health system was "sustainable and remained accessible into the future".

But Australian Medical Association president Steve Hambleton said if patients were forced to pay a small fee at emergency departments, there would be serious implications.

“We've only had free hospitals in Australia for three or so decades," he said.

"Try going back to the people who experienced the health system before then. They'll understand what the implications of this means."

The director of the St Vincent's Hospital emergency department in Sydney, Gordian Fulde, said he did not want to see emergency departments charging a small fee for service.

"One of the things we should be absolutely proud of in Australia is that people can go to an emergency department when they're in trouble and not worry about paying anything," Mr Goulde said.

Healthcare experts say Australia is already one of the most expensive countries in the world for out-of-pocket health expenses.

Data released by the National Health Performance Authority in March showed in some areas 15 per cent of people said they delayed seeing a GP because of the cost.

According to the Australian Institute of Health and Welfare, a little more than 18 per cent of total health funding comes from patients paying for out-of-pocket costs.

In 2009-10, out-of-pocket payments comprised 47 per cent of spending on medications and 61 per cent of spending on dental services.

In 2010-11, each Australian paid an average of $1075 out of their own pocket to access healthcare.

Philip Clarke, a professor of health economics at the University of Melbourne, said rather than "piecemeal changes" to the Medicare system, what was needed was a broader examination of the share of costs borne by patients across the entire health system, including on medications and diagnostic tests, to ensure a balance between sustainability, equity and efficiency.

In its submission to the Commission of Audit, the Consumers Health Forum says it would be opposed to any increase in co-payments in the health system.

"Consumers in Australia already bear the burden of significant out-of-pocket costs, and we question any approach that creates more disincentives in access to health care," the submission says.

Tracy Schrader, from the Doctors Reform Society, said if emergency departments started charging patients a fee then it would mean the "destruction of free point-of-service care".

“This is going to introduce a whole new layer of administration costs, about collection of money, about who's going to pay and who's not, and among GPs if they're going to have to do this too," she said.

But Mr Barnes said it would lead to a fair and sustainable system.

“I just don't think it would be a deterrent in itself from people accessing the care that they need," Mr Barnes said.

"It will bring money into the system. It's a fair and reasonable way all around."

SMH.COM.AU