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Concern about the ramifications of the $7.00 co-payment increased this week. 

The
Sydney Morning Herald quotes Sydney Local Health District CEO, Teresa Anderson, on the expected increase in patient presentations to emergency departments as a result of the federal government’s proposed co-payment. There is also a fear that patients, particularly from lower socio-economic groups, will delay seeking medical care until their condition has deteriorated and as a result place an increased burden on the public health system. 

This echoes the views of Northern NSW LHD CEO, 
Chris Crawford, in GPSpeak in June this year. He noted the tightening of future budgets due to a number of factors, including the loss of substantial revenue from formerly bulk billed radiology and pathology services.

The SMH is strongly opposed to the co-payment and questions the rigor with which the NSW Coalition government has petitioned its Federal counterpart to review it. NSW Health Department modelling of the effect of co-payments on hospital attendances had been kept secret until this week. In fact the existence of the model has been denied by NSW Minister for Health, Jillian Skinner, with her federal counterpart Peter Dutton labelling it as "numbers that have been cooked up by obvious union sympathisers within the New South Wales Health Department." 

If NSW Health's figures are merely "a back of the envelope" calculation it is hoped that the Federal modelling is more accurate, calculating savings to the Federal coffers of $3.6 billion over four years. It is also hoped that the cost shifting of primary health care back to the States is also "modelled".

The GP co-payment proposal appeared after the September 2013 Federal election in the workup to the Budget in May 2014. It has been described as unfair, untested and ideologically driven. It has no support from the Labor Party, Greens and nearly all the crossbenchers, and has been dropped from the government's current round of legislation due to Senate opposition. 

Minister Dutton has repeatedly said he wants to maintain Medicare but can only do that by making it affordable. A subtler and more nuanced alternative to the GP co-payment will be needed for him to succeed.