Payroll tax will push patients into EDs: Survey

Michelle Wisbey

14/02/2024 3:45:26 PM

Millions of patients could bypass their GP and head straight to hospital if the tax grab forces fees to rise, according to new HotDoc data.

Blurred photo of busy waiting room.
Around 95% of Victorian clinics plan to increase patient fees if payroll tax changes are imposed.

Victorian taxpayers could be slugged an additional $1 billion if the State Government ploughs ahead with its payroll tax agenda.
That is according to a new HotDoc survey of 1800 people, which revealed 4% of respondents would go to an emergency department rather than their GP clinic if consultation costs are to rise.
The analysis goes on to suggest that such an exodus would see an additional two million patients stream through Victoria’s already overwhelmed hospitals every year, at a cost of $1 billion.
It is a scenario that RACGP Victoria Chair Dr Anita Muñoz described as ‘horrifying’.
‘Patients are going to be faced with not seeing a GP who knows them best and can deliver them the care they need in the community and being forced to go into an emergency department, and I think that is inexcusable,’ she told newsGP.
‘Everybody is a loser in a situation like this, the patients get increasingly disjointed care, and we know that the more disjointed the care, the more expensive it is.
‘Patients need multiple episodes of care to get their needs met and often the emergency department is not able to meet their needs because it is not a place for preventive care and chronic complex disease management, it’s a place for emergencies.
‘So, we’re paying a premium price for people to use a service that is not designed for the problems they’re going there for.’
Around 8.8 million people present to emergency departments each year, with 2.2 million of those presentations in Victoria, according to the latest Australian Institute of Health and Welfare data.
At the same time, there were 50.4 million GP appointments carried out in the state.
Using this data alongside its own survey results, HotDoc says the imposition of payroll tax could lead to an additional 2.2 million presentations to emergency departments at a cost of $533 per presentation, totalling $1 billion.

The findings come just days after it was revealed that 95% of Victorian clinics plan to increase patient fees if payroll tax changes are imposed.
This would see a jump of around $12 for a standard consultation, with out-of-pocket costs likely to go up to $52.
Meanwhile, hundreds of medical centres remain at risk of closure in response to the Victoria Government’s stance on the highly controversial payroll tax change.
Earlier this month, HotDoc revealed 28% of patients would see their GP less frequently if fees increased, with 7% saying they would stop going altogether.
If nothing changes, Dr Muñoz believes Victoria’s health system is going to become ‘totally unsustainable’, especially with GPs already at breaking point.
‘I am almost at a point where I struggle to know what to say about this issue, so great is my frustration and dismay,’ she said.
‘Earnest discussions to try and prevent a health system disaster are being treated with such disregard and disrespect.
‘I am starting to form the view that until total catastrophe occurs, the decisionmakers and funders in the Victoria Government are going to continue to pretend that we don’t have a problem.’
Pressure continues to build on the State Government to scrap the tax or introduce concessions, with every other jurisdiction introducing measures to protect practices.
Victoria’s Opposition Health Minister Georgie Crozier said the new data is further proof the tax will drive thousands of patients away from their GPs.
‘This new tax will only add more pressure at the worst possible time. This is an insidious tax that will end bulk billing as we know it,’ she said.
In October, Victoria Treasurer Tim Pallas announced tax bills will be waived or reduced for clinics at risk of closure but has ignored GPs’ pleas for an amnesty.
Last week, the RACGP was among several general practice groups to write to Victoria Premier Jacinta Allan to request that she have direct involvement in finding a solution to the payroll pain.
The letter called for no retrospective collection of payroll tax liabilities, a new ruling clarifying that patients’ fees paid directly to a GP for their services won’t be subject to the tax, and a compliance period to allow practices to make changes to be in line with the ruling.
Dr Muñoz said since the letter was delivered, progress has been made.
‘Finally, after writing to the Premier we have been offered a discussion with the Treasurer, which we will be conducting,’ she said.
‘The Treasurer has signalled to us that he has no intention of changing anything but he’s willing to talk to us, so we will go to try and reopen this conversation and try and appeal to his good sense and good judgement.
‘We’ll do that so we can prevent the health system from falling into a hole that I’m not sure we’ll be able to get ourselves out of.’
A date is yet to be set for that discussion to occur.
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Dr Greg William Moritz   15/02/2024 7:28:33 AM

The Victorian government is incompetent, and have been for a long time. They seem to believe that, if they ignore the problem, it will simply go away. Extremely shortsighted (unless it's in relation to a useless rail circle). And very stubborn, too. I'm not even sure that they'll recognise when the health system has collapsed. Good luck trying to deal with them. Their modus operandi is to tax (payroll), tax (land) and tax to feed that ever increasing bottomless pit of debt. And unfortunately no end in sight given the political landscape in this part of Australia.

A.Prof Christopher David Hogan   15/02/2024 8:07:00 AM

Tragedy has many forms but watching various successive governments destroy a perfectly good health system is a particular form of torture.
Denmark & others like The Netherlands have proven how cost effective & satisfying a GP led health system can be.
Relatively recent research has elucidated the sophistication of good General Practice as it deals with incredible complexity & significant uncertainty.
GP is not & has never been simple.
The relatively recent revelation that consistent continuity of care by GPs provides a better health outcome by 10-30% compared to care provided by varying individuals .
See this single simple summation
GP visit <$100 -consistent care, ED visit >$ 900- inconsistent care

Dr Greg Saville   15/02/2024 9:11:02 AM

I would take the HotDoc data with a large grain of salt. It is unclear whether the 72 people (4%) surveyed who said they would go to ED were given the option of visiting an urgent care clinic. Anyway the analysis seems a bit dodgy. The population of Victoria is about 6 million. 4% of that is 240,000. So to get to the 2 million extra ED visits, every Victorian man, woman and child would need to attend ED over 8 times a year - a visit every 45 days!

Here’s an idea, why don’t all practices open their doors until 8 pm every night and open on the weekends from 9am to 5pm? This would take the burden off ED’s. Additionally, keep some “book on day” appointments for your regular patients. In the meantime if your patients have an urgent problem that needs attention, send them to one of the hundreds of urgent care clinics (supported by thousands of very good GP’’s) that have opened around the country (Cat 4 and 5 only please).