Australia's leading expert on health inequality has warned the Abbott government against introducing $6 co-payments for doctor visits, saying it could have dangerous consequences for the poorest and sickest.
A $6 fee for doctor visits would discourage the wrong people from visiting the doctor while doing nothing to dissuade those who already see their GPs too much, the director of the public health information development unit at the University of Adelaide, John Glover, said.
Professor Glover, who has led Australia's most detailed analysis on the correlation between a person's wealth and their willingness to visit a doctor, said there was "very strong" evidence that poorer people were already under-using healthcare in proportion to their level of illness.
Those living in the poorest neighbourhoods are more than three times more likely to delay medical consultations because of costs than those living in the wealthiest suburbs.
The data – which is the only set of its kind – comes from Professor Glover's modelling of a 2010 Bureau of Statistics survey of more than 15,000 households.
If the government scraps Medicare bulk-billing in favour of a standard $6 fee, as proposed by Tony Abbott's former health adviser Terry Barnes, those most likely to get seriously ill would, perversely, be more likely to avoid preventive medicine. "It's a step towards reducing what we have as a universal healthcare system," Professor Glover said.
He joins a chorus of alarm from public health specialists and medical peak bodies, who are worried that neither the Prime Minister nor Health Minister Peter Dutton have distanced themselves from the controversial proposal.
In a submission to the federal government's Commission of Audit, Mr Barnes said the government would save $750 million over four years by forcing patients who bulk-bill to pay $6 to visit their GP for the first 12 visits a year.
The Royal Australian College of General Practitioners said it was concerned "equitable access to clinically appropriate healthcare will be jeopardised".
The concerns appear to be supported by the only data available that tracks socio-economic status against a person's likelihood to delay visiting a doctor.
According to Professor Glover's analysis, only 5 per cent of residents of Mosman, Woollahra and Hunters Hill – among Sydney's wealthiest neighbourhoods – said they had delayed medical consultations because they could not afford them.
But in less wealthy areas, such as Penrith (13.5 per cent), Nambour in Queensland (23.4 per cent) and Ballarat in Victoria (17.9 per cent), residents were much more likely to delay visiting the doctor because of the cost.
The health program director at the Grattan Institute, Stephen Duckett, said the Abbott government would get a "bad policy outcome" if it followed Mr Barnes' advice. "In the healthcare system there's a trade-off between costs and equity," he said.
By introducing a $6 fee, the government "might save money in the short-term at the cost of equity", Dr Duckett said. Emergency departments would soon fill up with patients who had delayed seeing their GPs for preventive medicine.
"It's the low-income families who are not using healthcare to the extent they should," Dr Duckett said.
with Gareth Hutchens