He repeated the comments in an interview with the ABC's 7.30 later that night calling for a debate on the co-payment proposal, saying there were arguments for and against it. ''I want to make sure that, for argument's sake, we have a discussion about you or me on reasonable incomes, whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test – should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill?'' he said. ''Many Australians already pay a co-payment when they go to see a doctor. Now, the issue is how you guarantee access, particularly for those who are without means, and how you don’t deter people from going to see a doctor if there is some sort of a payment mechanism in place.'' A proposal had been advanced to the Commission of Audit by a former adviser to Prime Minister Tony Abbott, Terry Barnes, for a $6 fee to see a GP or for presenting at a hospital emergency department for GP-type treatment. Mr Abbott would not say on Thursday whether he would consider the idea of GP co-payments to relieve pressure on the health budget.

''Obviously, the budget generally is under pressure,'' Mr Abbott said. But he added that the government needed to make savings in ways that were ''consistent with . . . pre-election commitments''. During the election campaign Mr Abbott promised not to make any overall cuts to the health or education budgets. ''I want this government to be . . . the best friend that Medicare every had,'' he said. Addressing a Committee for Economic Development of Australia event in Brisbane on Wednesday, Mr Dutton said factors such as ageing, the growing prevalence of diseases such as diabetes and Alzheimer's disease and new technologies had placed the health system ''on an unsustainable path''. Treasury forecasts annual Commonwealth health spending will grow from the current level of $62 billion to $75 billion by 2016-17, and balloon from its current level of 4 per cent of GDP to 7 per cent by 2050.

As the government considers the initial recommendations of its Commission of Audit and prepares for what is expected to be a horror first budget, Mr Dutton warned: ''Doing nothing about sustainability is just not an option.'' Labor and health groups have savaged the idea, predicting it would hit the poorest and sickest hardest and would be unlikely to generate significant savings. Labor's health spokeswoman Catherine King seized on Mr Dutton's comments, accusing the Abbott government of seeking to ''dismantle'' Medicare by introducing a ''GP tax''. ''The introduction of a GP tax will reduce access to doctors for all Australians,'' she said on Thursday in a statement. The Australian Medical Association was concerned a co-payment would deter people from seeing their GP.

''We don't want to create a situation where people defer seeking healthcare, and that might be expensive later,'' president Steve Hambleton told ABC Radio on Thursday. Grattan Insitute director of health program Stephen Duckett said on Thursday that a co-payment was ''just a pimple on a pumpkin''. ''It doesn't raise much money – it may not raise any money if people go to a hospital emergency department instead. What you’ve got to do is say: how do we help people with a chronic illness look after themselves? A six dollar co-payment is an irrelevancy,'' he told the ABC.



Dr Duckett said the government should focus on improving electronic health records and consider raising the Medicare levy.



Univeristy of NSW Emeritus Professor of Medicine John Dwyer said there were fairer and more effective ways of reducing health costs than a Medicare co-payment.



Professor Dwyer said the government should focus on preventive health and reducing duplication in the state and federal health bureaucracies.



''Before you would ask Australians to pay more for their health it's the responsibility of governments and healthcare professionals to look at the system and say: are we wasting a lot of money?'' he told ABC Radio. ''We are wasting a lot of money. People overseas can't believe a country of 23 million people has nine departments of health.''



He said the fairest way to deal with the increase of the cost of health care was to increase the Medicare levy. Mr Dutton has also signalled a willingness to allow private health insurers to cover GP services. Consumer advocates argue this would exacerbate the shift towards a two-tiered system, in which those with private cover receive a higher standard of care than those who can't afford insurance. But on Wednesday, Mr Dutton said the nation should be open to a greater role for private insurers in keeping their 11 million members healthy.

''Private insurers have as much interest as I do in helping people avoid inappropriate admissions to expensive tertiary hospitals,'' Mr Dutton said. ''Why should we see the private sector involving itself in public services as a bad thing?'' He said federal, state and territory governments covered about 35 per cent of the cost of private hospital services, but about 92 per cent of the cost of treatment in public hospitals. Responding to Medicare architect John Deeble's recent suggestion of raising the Medicare levy to help meet spiralling costs, Mr Dutton said to cover the entire cost of the Commonwealth health budget, the levy would have to increase from its current level of 1.5 per cent to 9.5 per cent. The levy will rise to 2 per cent in July to help fund the National Disability Insurance Scheme.

Mr Dutton said much of the health budget was spent on a relatively small cohort of people. Last financial year, 10 per cent of patients accounted for 46 per cent of Medicare spending and 58 per cent of Pharmaceutical Benefits Scheme spending. While some medicines cost the government as much as $17,000 per script, patients only pay $36.90 while those with concession cards pay only $6. But Mr Dutton promised the government would ensure ''that those who are least able to look after themselves, will in fact be looked after''. Loading with Matthew Knott and AAP