A publication of the Centre for Advancing Journalism, University of Melbourne

Some states to feel the sting of Medicare co-payment when vaccinating children

Victorian parents wanting to immunise their children are well placed to avoid the proposed $7 GP co-payment by using free council immunisation clinics, while those in other states could struggle to find alternative providers.

Nationwide, three-quarters of childhood immunisations that are reported to Medicare are given by GPs, but this varies from as low as 9 per cent in the Northern Territory to 88 per cent in Tasmania. Victoria has the lowest proportion among the states, with 55 per cent of immunisations provided by GPs.

Federal Health Minister Peter Dutton has declared that all visits to GPs will attract the co-payment, including visits for childhood immunisations.

The co-payment will only apply if the immunisation is provided by a GP. Alternative, free immunisation providers include local councils, community health centres and Aboriginal health centres.

But the Australian Medical Association has expressed concerns that the co-payment will dissuade parents from immunising their children at a time when health experts are warning that Australia could face epidemics of polio, measles and other communicable diseases if the number of people vaccinated falls below criticial levels. Already, they say, immunisation rates in some areas of the country are dangerously low.

The co-payment will only apply if the immunisation is provided by a GP. Alternative, free immunisation providers include local councils, community health centres and Aboriginal health centres.

In the Northern Territory, 72 per cent of immunisations are given at community health centres and a further 13 per cent at Aboriginal health centres.

In Victoria, the Public Health and Wellbeing Act 2008 requires every council to provide childhood immunisation services, with immunisations provided free through council clinics or council-funded secondary school clinics accounting for 43 per cent of childhood immunisations.

GPs in NSW, Queensland and Tasmania have close to a monopoly on childhood immunisations. This contradicts the aims of the National Immunisation Strategy for Australia, 2013 – 2018, which states: “The availability of a diverse network of providers helps to ensure immunisation services are accessible and enables consumers to select their preferred immunisation provider.”

WHERE CHILDREN GET VACCINATED

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Source: Medicare

The Queensland government has already flagged providing free vaccination clinics to offset the risk that the co-payment will lead to a reduction in childhood vaccination rates. The state already has the lowest rates of immunisation in the nation, with 4100 parents listed as conscientious objectors.

Only 92 per cent of four-year-olds in Queensland have been fully vaccinated. Of those who remained unvaccinated, about a third had parents who objected to immunisation, according to official data.

The Australian Childhood Immunisation Schedule recommends that children receive vaccines at birth, two months, four months, six months, 12 months, 18 months and four years, and then twice during secondary school.

Vaccines on the schedule are supplied to providers free by the federal government, and the providers are paid $6 for every immunisation that is reported to the Australian Childhood Immunisation Register, but this does not cover the entire cost of providing these services.

The City of Monash, in Melbourne’s south-east, has budgeted $316,000 for immunisation services for 2014-15 but only expects $150,000 in income, which means one-half of the cost of providing immunisations is borne by the council itself.

Only 92 per cent of four-year-olds in Queensland have been fully vaccinated. Of those who remained unvaccinated, about a third had parents who objected to immunisation, according to official data.

Overall, the number of immunised children in Australia actually rose by 2000 in 2012-13, according to data compiled by the National Health Performance Authority.

There were 75,000 children aged one, two and five that were not fully immunised according to the report, which was released earlier this year.

The release of the report coincided with the World Health Organisation declaring Australia “measles free” on March 20, although the Director of Research at Monash Children’s Hospital, Jim Buttery, cautioned that it was too early to celebrate.

He said that “herd immunity” was necessary to prevent epidemics, and if fewer people were being vaccinated this could be lost.

Queensland Health has issued warnings for residents of south-east Queensland in the light of a series of recent outbreaks of measles.

For measles, the “herd immunity threshold” is between 83 per cent and 95 per cent of children being immunised. Dr Buttery said that as long as this rate of immunisation was maintained, non-immunised children would also gain some protection.

However, should the percentage of immunised children fall below these thresholds, it could lead to an epidemic.  

This concept of  “community immunity” also applies to other diseases such as polio, diphtheria and pertussis (whooping cough).

Stephen Lambert,an immunology expert and associate professor at Queensland Children’s Medical Research Institute, said that it was important that people did not become complacent upon learning that Australia had been declared “measles-free”.

“The measles-free status can only be maintained if high vaccination rates are sustained,” Dr Lambert said. “That means parents get their kids vaccinated, and adults ensure their immunisations are up-to-date, too.”

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