Common sense prevails

Greetings all,

Like many of my medical colleagues I am celebrating today with the news that the Federal Government’s GP co-payment system is all but defunct, despite incongruent press releases throughout the day. The co-payment system is thought to affect GP visits but many don't know it was desgned to involve radiology and pathology services as well. I don’t know how this has been overturned. I hope it was because common sense and benevolence won in the end. But regardless, I care because now there is a chance my vulnerable patients will still be able to access the treatment they deserve in a country such as Australia.

I wrote about the injustice of co-payments for those with severe mental illness on Croakey in June 2014, found here. My main point was that it was inhumane to impose fees for medications and diagnostic services on an involuntary patient who was being treated under the Mental Health Act, because of the fact that they were refusing treatment or unable to consent to treatment. I wrote it at a time too when I was working in a large city and struck by the amount of homelessness and poverty even in inner urban areas. I wanted to tell those who would listen that there must always be free health care for those most unlikely to advocate for themselves or pay for it.

As I wake to this news today I am working as a psychiatrist in a rural area servicing a large population and geographical area. Many patients are indigenous, many are also kept well by the public health system. As stretched as it is, staff are genuine and truly caring of their patients. I have been able to see how medications such as clozapine have actually turned the lives around of patients with severe mental illness, keeping them out of hospital for years. 

As I wrote earlier in the year, patients prescribed clozapine require weekly to monthly pathology tests to ensure they are not developing  life threatening side effects. They cannot pay for treatment and some are receiving treatment under the Mental Health Act, hence unable to consent to it. I know that if they had to pay $7.00 every week for 18 weeks for blood tests many would stop medications and become severely unwell, maybe even requiring months in hospital to recover. I suggest it best they receive outpatient care in an evidenced based manner rather than risk a relapse that would disrupt their lives or potentially place their lives at risk.

I was impressed to hear Dr Brian Owler, federal president of AMA, speak about the GP co-payment system today. I support his continued requests to work with the government on finding a better solution to funding care. I am not stating all patient should be bulk-billed. But I am very aware that to remove this advantage for everybody will leave an incalculable dent in the health care budget, notwithstanding poor patient outcomes and more strain for health care professionals that work in a stretched health system.

It’s Ok to make a mistake once, we all do. But if our current federal government doesn’t learn from this mistake by continuing to ignore key stakeholders such as the AMA and patient lobbying groups to my mind that would be reprehensible. 

Dr Helen Schultz is a consultant psychiatrist at 'MindAdvocacy' Richmond, Melbourne, Australia. She is the author of "How Shrinks Think" published November 2014.