Money talks: Proposal to give patients more say in what to pay

Four in 10 Australians say they should have great control of how much they pay for a GP visit, Monash University research shows.

  • Four in 10 Australians say they should be able to determine how much they pay for a GP visit, under a new funding model proposed by Monash University researchers.
  • The study found patients would be willing to make voluntary out-of-pocket payments of $25 in return for shorter waiting times and longer consultations.
  • Results suggest that patient-chosen prices to primary care could generate an extra $1.48bn in revenue while also boosting patient-centred care.

Four in 10 Australians believe patients should be able to determine how much – if anything at all – they pay for a GP visit, new research by Monash University shows.

This study by the Monash Business School and Monash School of Primary Health & Allied Health Care tested a new model of primary health care where patients would determine how much they would pay for a GP visit.

Under the ‘Patient-Chosen Gap Payment’ (PCGP) model, patients could choose to pay any amount for their GP consultation – from nothing to, potentially, much more than the average out-of-pocket ‘gap’ payment.

The survey of 1,457 Australians found 39 per cent of patients 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 research, published in the journal Social Science & Medicine, found patients would be willing to make voluntary and patient-chosen payments of $25 in return for shorter waiting times and longer consultations.

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.

According to Associate Professor Duncan Mortimer from Monash Business School’s Centre of Health Economics, the proposal does not mean GPs would see patients for ‘free’.

The GP would continue to get the Medicare rebate for each patient. The patient would determine the out-of-pocket or ‘gap’ payment.

“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,” Associate Professor 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,” Associate Professor Mortimer said.

“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.”

Services and procedures provided on a fee-for-service basis are subsidised via the Australian Government’s Medicare Benefits Scheme. Doctors can bulk bill patients and accept the Medicare rebate as full payment for their services.

According to the researchers, GP groups have long argued the Medicare rebate is insufficient to cover costs and that it doesn’t reflect the value of GP visits to patients.

Research co-author, General Practitioner and PhD student at Monash’s Department of General Practice, Dr Daniel Epstein, believes the PCGP model could provide a happy medium between compulsory out-of-pocket payments and bulk billing.

“There’s always a fine balance between providing good patient-centred GP care without limiting access to people based on their ability to pay,” he said.

“Patients’ willingness to make voluntary contributions may come as a surprise. 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.

Associate Professor Duncan Mortimer and Maame Woode (Centre of Health Economics, Monash Business School); and Dr Daniel Epstein, Professor Danielle Mazza and Dr Chris Barton (Department of General Practice, Monash University) were involved in this study.

To read the full article, please visit Monash Impact.