Bulk billed GP appointments are becoming a rarity, with a new report showing that the number of clinics bulk billing all patients dropped by more than 500 in the last year.
Cost of living pressures are pushing GPs to increase their fees which are then being passed along to patients, resulting in increased out-of-pocket costs.
The independent healthcare directory Cleanbill, contacted nearly 7,000 clinics across Australia for its 2024 survey and found that the national bulk-billing rate for doctors accepting new patients has dropped to just 24.2%. It’s a decline of 11% within a single year.
To make matters worse, bulk billing coverage varies depending on where you live, with some states having all but lost their Medicare coverage for doctor visits.
Royal Australian College of GPs President Dr Nicole Higgins has said the report indicates the urgent need to do more to protect bulk billing and ensure everyone has access to healthcare.
“This report shows we need to do more to address the rising costs for care in Australia – patient financial issues was also one of the top concerns GPs reported in our 2023 Health of the Nation,” she said.
What Is Bulk Billing?
Bulk billing is the practice of sending the bill for a medical visit to Medicare instead of the patient directly. When they do so, they take the standard fee for a service from Medicare, instead of a higher payment from the patient.
Often clinics will do both, bulk billing some of the cost of the appointment and charging the patient for the rest. This is known as the ‘gap’ or the ‘out-of-pocket’ cost. It’s called bulk billing because the practice will invoice Medicare for a total number of services over a given time period in bulk.
How Much Do Doctors Get Paid for Bulk Billing?
Medicare will give doctors $41.50 for a standard 15-minute appointment. If the clinic needs to charge more, and almost all do, in order to keep the lights on and pay operational costs, they charge a higher fee which Medicare will cover part of, up to the cost agreed.
In order to encourage doctors to bulk bill, the government has a range of bulk billing incentive payments. This is extra cash that Medicare will shell out for things like bulk billing people under the age of 16, those who have healthcare cards, or are in specific areas.
In November of last year, the government tripled a range of bulk billing incentive payments, increasing the amount doctors can get for some appointments and therefore the likelihood that they will bulk bill.
While the Cleanbill data does cover a period of these introduced changes, it’s not enough to give a good understanding of how they might have affected the system.
While the government’s tripling of bulk billing incentives has helped more GPs bulk bill specific groups, including children, pensioners, and healthcare card holders, more needs to be done to ensure care is affordable for the rest of the population,” Higgins has said.
Is Bulk Billing Ending in Australia?
The figures for declining bulk billing rates suggest that while there is much talk of reviving bulk billing and Medicare, the practice may well have already ended for many people.
The Clearbill survey shows that just a quarter of clinics in Victoria still bulk bill new patients. In New South Wales, the state most likely to bulk bill, 37.2% of clinics do so, down from 48.6% at the start of last year. In WA, that figure drops to just 10% while in Tasmania there is just a single clinic that still bulk bills new patients.
More needs to be done to boost the general practice workforce, so every Australian has access to the care they need.
— RACGP (@RACGP) January 4, 2024
Higgins put the decline of the practice down to a decade or more of under-investment, following a ten-year freeze on Medicare rebates. This stopped the payments from increasing in line with inflation and pushing GPs to bill patients directly.
“Even though more people access general practice than any other health service, it gets just 6.5% of the total government spend on healthcare,” she said.
Cost of living pressures and a recent shift in taxation status has created even more pressure on GPs, Higgins explains.
“While practices have always paid payroll tax on their employees, it never applied to GPs because they work under independent agreements, but this changed after a new interpretation of payroll tax law.”
The RACGP has stated that states and territories need to implement tax changes to reverse the new status of doctors. So far, only Queensland has done so. Without protection, they predict there will be more practice closures. 184 shut last year owing to unaffordability.
Changes to the bulk billing system were one of the flagship policies of Labor’s 2023 budget and part of a $3.5 billion package. This included the opening of 58 new urgent care clinics for people who have a non-life-threatening need for care. All of them are fully bulk-billed.
However, critics have said that it’s not enough to address the ‘crisis’ in the system. A similar report at the end of last year found that the number of doctors who bulk bill all patients had halved over the last 12 months.
That report also found that job satisfaction was sliding amongst GPs, with far fewer of them saying they would recommend the career to junior medical practitioners. The RACGP has called for greater investment to prevent a loss of affordable healthcare.
“The government knows action is needed and they’ve committed to rebuilding Medicare and general practice. While there’s no quick fix, we do need to keep up the momentum to secure the financial sustainability of general practice, enable bulk billing for those who need it, and ensure GP care is affordable for everyone,” Higgins said.