Charge emergency patients a fee to fix ramping, Pederick suggests

State MP Adrian Pederick has sparked a row in parliament by suggesting a solution to the ramping crisis he admits would be highly unpopular.

Peri Strathearn

Aug 29, 2024 — 3 min read

State MP Adrian Pederick has suggested city emergency patients be charged a gap fee, like patients in Murray Bridge, to reduce pressure on Adelaide's overcrowded hospitals. Image: Peri Strathearn.

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A new fee for emergency patients, and investment in country hospitals, could help fix South Australia’s ramping crisis, state MP Adrian Pederick has suggested.

The issue of overcrowding in hospital emergency departments – and patients being left in ambulances on the ramps outside – has been the biggest issue in South Australian politics since the 2022 election, when now-Premier Peter Malinauskas made it the central plank of his campaign.

In parliament on Wednesday, Mr Pederick suggested a novel solution: charge a gap fee to discourage people from showing up to emergency departments.

Emergency patients in Murray Bridge and other regional centres already paid a fee if they were able to be treated and sent on their way – why couldn’t city patients do the same?

The idea would be deeply unpopular and impossible to sell politically, he said; and it was not official opposition policy.

But South Australia had spent billions trying to fix the problem over the past few years, and for what?

“If there was a gap fee for people turning up to emergency who did not get admitted, I think you would see a drastic reduction in people attending emergency departments,” he said.

“I do not think it would be something politically saleable for probably anyone, but the reality is that there are billions and billions of dollars being forged into SA Health and it takes 30 per cent of the state's budget, but where are we going?

“There is more infrastructure being built, more people not being able to access general practitioners, and more people being ramped for over 100,000 hours, I think, since Labor came into office (in 2022).”

There would have to be safeguards on any hypothetical fee system, he told Murray Bridge News, to ensure vulnerable people could still access the care they needed.

The state government has so far relied on public awareness campaigns to discourage people from visiting emergency departments unnecessarily, and suggesting that they call the Healthdirect help line instead.

Chris Picton, centre, has criticised the idea of a gap fee in hospital emergency departments as a "patient tax". Photo: Chris Picton/X.

Government, opposition agree gap fee will never happen

State Health and Wellbeing Minister Chris Picton quickly seized on Mr Pederick’s remarks for a political attack, describing the idea as “shocking” and a “patient tax”.

He urged Opposition Leader Vincent Tarzia to admonish Mr Pederick for speaking out, and defended the government’s record on health spending.

“This government is pulling every lever it can to reduce pressure on our health system,” he said.

“We are building 600 new beds, including opening an extra 330 by the end of next year – the equivalent of a new Queen Elizabeth Hospital into the system.

“We have also hired more than 1400 additional doctors, nurses and allied health workers above attrition since coming to government, and are making a generational investment in the SA Ambulance Service.”

A spokesman told The Advertiser on Thursday that the idea of an emergency department fee was not official opposition policy, and would not be in future.

Still, for what it’s worth, an Advertiser poll showed two thirds of readers in favour of the idea.

Mr Pederick told Murray Bridge News he had received numerous messages of support from members of the public in the 24 hours since he made his speech.

Country hospitals need investment, Pederick says

An investment in hospitals like Murray Bridge’s could also help reduce emergency department overcrowding, Mr Pederick told parliament.

Country people took up 30 per cent of Adelaide’s hospital beds, he said; treating those patients elsewhere would open up a lot more capacity in the health system.

Murray Bridge, for one, would need expanded services, and eventually a new hospital.

“I think it would be a lot smarter investing billions of dollars into country health services right across the state than what I see as some of the waste going into a project that is not fixing the problem that the Malinauskas Labor government said they would fix,” he said.

SA Health has long defended the patient-pays arrangement in Murray Bridge as a cheaper alternative to having salaried doctors on hospital staff, especially when country GPs are already in short supply.