Those who refuse vaccines must pay for the pressure they put on hospitals


Contrary to what is often said, access to public health care in Australia is not free. It costs the taxpayer nearly $ 100 billion every year. That’s about $ 4000 per resident or 6.5% of GDP. Our total spending on health – both public and private – is 9.4% of GDP.

That money comes at the expense of other potential areas of public spending. Every dollar spent on health care is a dollar that cannot be spent on education, infrastructure or defense, or simply left in taxpayers’ pockets.

Local outbreaks of SARS-CoV-2 have put pressure on public hospitals. Treating COVID-19 patients uses resources that can be spent on other health problems or in other areas of public policy. Given that, one, we now have strong evidence that vaccination significantly reduces the risk of not only transmitting the virus but also of hospitalization and death, and two, vaccines are now readily available in Australia, the debate on how to deal with whom. rejecting vaccines seems legitimate enough.

Denying treatment to those who are eligible but refuse, as touted by the Victorian AMA, is rather unpleasant. A public system must treat all participants based on need and the ability to benefit from them. End of the story.

The primary lever for addressing vaccine hesitation and minimizing rejection must be public education. Mandates play a role. But there may be an attractive way to incentivize vaccination Other recover part of the costs of the additional treatment.

All taxpayers pay a 2% annual Medicare contribution. Medicare is the federal scheme that funds general practice and specialist care, with individual patients paying the “gap” between their Medicare dues and what their doctor charges.

In addition, families who do not have private hospital coverage face a surcharge of 1%, 1.25% or 1.5% depending on their taxable income. In the absence of an equivalent levy for public hospitals, a similar regime could be introduced for those who refuse vaccination without a valid exemption.

This would ensure continued access to care while recovering some of the financial burden created by refusing to participate in traditional, evidence-based public health intervention.

Such a scheme would be relatively easy to coordinate, given that the vaccination status is binary and easily recordable: the logistics would be much simpler than (accurate) verification of the vaccination status in places or shops. This distinguishes it from behavioral risk factors that increase healthcare use such as smoking or poor nutrition, which are not only difficult to objectively quantify, but also related to socioeconomic status and potentially difficult for individuals to change.

It doesn’t have to be regressive. If there is a social gradient for vaccine hesitation, as there is for obesity and smoking, it is taken care of by a progressive design. Just like the private hospital surcharge, a marginal rate may apply and low-income workers may be exempt. The rich who refuse would then be charged disproportionately more than the poor. A potentially elegant solution.

There is the argument of coercion. Yes, it is a financial incentive to get the vaccine. But then we tolerate a financial incentive to purchase private health coverage, a policy explicitly designed to “encourage people to take out hospital coverage for private patients and use the private hospital system … [and] reduce demand from the public system “.

Perhaps proponents of the coercion argument should also adopt a number of other similar policies: punitive tobacco taxes, traffic violation penalties, compulsory schooling, or even “no jab no play” warrants for assistance. childhood.

Should we worry as Australia is still on track to be one of the most vaccinated populations on earth? The answer is probably yes, both epidemiologically and politically. Financially it would depend on the exact numbers and design.

Getting as close to 100% as possible will suppress the possibility of vaccine resistant variants, although of course this has to be a global effort. This is a stated reason why, despite reaching 85%, Singapore will soon charge COVID-19 patients who refused to be vaccinated without a valid exemption for their medical bills.

Politically it is a sign that there are a small number of democratic obligations which, if respected by all, generate the many freedoms we enjoy. Vaccination is a modern embodiment of these.

All political interventions carry the risk of unintended consequences. A supplement may give vaccine rejects a self-ordinated license to refuse other restrictions. “I paid my own way so it’s unreasonable to deny me entry into this [insert place where vulnerable people could be at risk]”It would be a deplorable result.

However, we should consider policies that discourage people from endangering the health of fellow citizens without a reason in line with secular and democratic values.


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