Rural Australians generally have poorer health outcomes and lower incomes than their urban counterparts and many rural medical practices struggle to remain financially viable, as they often have to subsidise the cost of consultations for patients they know cannot afford to pay. In addition, rural doctors subsidise their communities during times of drought or disaster.

Under the proposed co-payment requirement, rural doctors will face a tough choice force more of their struggling patients to make the co-payment, or treat more of their patients free of charge and, in the process, take an even greater pay cut and put more pressure on their practices' viability.

Many other questions about the co-payment remain unanswered.

For example, what will happen with an elderly patient who is in a nursing home and incapable of managing their finances? Or the dying patient in the final weeks of palliative care, who is seen by the doctor at home? Is the GP really expected to collect $7 from these patients before providing treatment?

What about the disabled, or those from disadvantaged backgrounds, who may now have to forgo a visit to the doctor so they can feed their children? What will the impact be of yet another barrier to them seeking healthcare?

Most importantly, what about our indigenous patients? All the gains made in closing the gap on their lower life expectancy may be lost as a result of this budget measure.

And when these and other patients become chronically ill and enter the hospital system, has the government estimated the flow-on costs of this?

The other underestimated impact of the co-payment is on rural doctors themselves.

Many rural doctors provide care not only at their general practice, but also emergency, obstetric and other care at their local hospital. This makes for an extremely heavy workload, with doctors called to the hospital at any time of the day or night.

If this workload isn't enough, they will now have to collect the co-payment on behalf of the government and meet the associated red-tape requirements.

No doubt their after-hours call-outs to the hospital will also increase as more patients present at the local emergency department because they can't afford to make the co-payment to see the doctor at their practice, or they have delayed seeking treatment because of the additional cost

involved.

We urge the Federal Government to reconsider the proposed Medicare co-payment budget model, given the significant and negative impact it will have on rural communities and rural practices.