Despite the Australian government pumping extra money into the budget allocation for bulk billing last year, fewer GP clinics than ever are willing to take new patients covered only by the subsidy and are increasing out-of-pocket charges.
Bulk billing was introduced in 1984. A range of health services and prices are listed in the Medicare Benefits Schedule, and under the scheme, a health services provider—usually a GP—is paid between 75 and 100 percent of the scheduled fee for inpatient services by billing the government via the patient’s Medicare card.
For what most people would consider to be a typical GP visit, “lasting at least six minutes and less than 20 minutes” and involving discussing the problem, performing an examination, and providing the appropriate care, the government will pay a GP $42.85 (US$26.51), which is 100 percent of the set fee, meaning a standard visit to a bulk billing doctor is free.
But providers aren’t obliged to charge according to the schedule, and the number willing to do so is shrinking.
That’s despite the government announcing a $1.5 billion indexation boost to Medicare payments in the 2023/24 Budget, targeted at families with children under 16, pensioners, and concession card holders. It gave a meaning $21-per-visit bonus to GPs in cities and almost $40 to those in regional areas.
But Healthcare directory Cleanbill says that hasn’t been enough to cope with increasing demand.
Its annual survey of nearly 7,000 GP clinics found Australia’s bulk-billing rate had plummeted to 20.7 percent of all consultations at the start of this year, down from 35.7 percent two years earlier.
No New Bulk Billed Patients in Some Areas
In some places, it’s impossible for new patients to find a GP who will bulk bill, with the study finding no clinics in Tasmania that would take a new adult patient without charging a co-payment, The state also has the largest average out-of-pocket cost at $54.26.Across the last three years of Cleanbill surveys, every state has seen an annual decrease in its bulk-billing, rate combined with an increase to the average out-of-pocket cost.
The Australian Bureau of Statistics’ patient experiences survey, released in November last year, found about 1.5 million people with a health complaint did not attend a GP due to cost.
Cleanbill founder James Gillespie said the data was “absolutely concerning, but ... not particularly surprising. Anyone who’s gone to see a GP in recent years knows how few bulk-billing clinics remain and how high out-of-pocket costs can be.
More Still Needs To Be Done: Minister
But federal Health Minister Mark Butler disputed Cleanbill’s figures, which are considerably lower than the government’s official bulk billing rate of 77.2 percent in November.Government figures show the ratio of all individual GP visits that were bulk billed, compared with Cleanbill’s study, which references clinics that would bulk-bill a new adult patient without concessions.
“Official data shows our record investment to strengthen Medicare has stopped the free-fall in bulk billing that was created under the Liberal and Nationals government,” Butler said.
“Every state and territory now has more bulk billing, with the largest rise in some states which have historically struggled with lower rates of bulk billing, [but] we know there’s more to do to keep strengthening Medicare after a decade of cuts and neglect.”
Despite the previous boost, Royal Australian College of General Practitioners President Michael Wright said an increase in Medicare funding should be front-of-mind heading to this year’s federal election.
“Medicare has been underfunded for decades,” he said. “Today’s patient rebates don’t come close to the cost of care, so people are paying more out-of-pocket, [and] it’s harder for GPs to bulk bill.”
“When people can’t see their GP or delay care due to costs, their health gets worse and they are more likely to end up in hospitals … that’s bad for their health, and costs taxpayers more,” he said.
