GP patients’ out-of-pocket costs outstrip Medicare rebate as bulk-billing falls to near-decade low

“Primary care is in its worst shape since Medicare began … Across the country, we hear stories of Australians not being able to get in to see a bulk-billing doctor or GPs changing from bulk-billing to mixed billing,” he said.

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Public health researcher Dr Christopher Harrison, from the University of Sydney, said there was scepticism around the official Medicare figures, which calculate the overall rate of bulk-billed services rather than the portion of patients who are able to access them.

“I find these numbers surprisingly high, given there are many areas now where it’s nearly impossible to find a practice that will bulk-bill,” he said. “But still, we’ve had our first drop in 2021-22 after years of increases [in the data].”

Alternative data produced by online healthcare directory Cleanbill, which surveyed 4188 Australian GP clinics in the final six months of last year, indicates a sharper decline. Its survey found only 42.7 per cent of GP clinics were offering bulk-billing to all patients, while the average gap fee for the clinics that did not bulk-bill was $40.25 for a 15-minute consultation.

Health economist Stephen Duckett said only about two-thirds of the population had all their GP attendances bulk-billed.

“The second thing is that it is very unevenly distributed. Wealthy suburbs have a much lower portion of attendances bulk-billed, but importantly in some parts of rural and regional Australia there are also low rates,” he said.

“That information is not easy to come by and there’s not enough transparency as there ought to be.”

Butler said he had asked his department for more complete and accurate data on the state of bulk-billing in Australia.

“The former government was not honest with Australians about the true state of bulk-billing in Australia by selectively quoting figures,” he said.

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Harrison said the increase in doctors’ fees was understandable given Medicare rebate rises had traditionally been below inflation or frozen for years at a time.

“My concern is not the size of co-payments, but the fact that they are happening at all,” he said.

“If we want a world-class healthcare system then we don’t want a financial barrier to general practice, which is one of the most cost-efficient forms of healthcare our system has, certainly more so than emergency department visits.”

The Australasian College for Emergency Medicine this week released an informal survey of its members that backs the premiers’ concerns. It found emergency department directors were expecting widespread shortages next year due to unsustainable working conditions, including shortfalls of 28 per cent for specialist trainees, 30 per cent for junior medical officers and 10 per cent for senior decision-makers.

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Andrews and Perrottet are calling for changes to Medicare rebates to improve GP pay and take pressure off state hospitals. The Australian Medical Association and Royal Australian College of General Practitioners support similar policies but have said billions in extra funds would probably be needed.

A federal taskforce on Medicare reform will finalise its report this month and Labor has promised to use the $750 million Strengthening Medicare Fund to enact its recommendations.

However, some taskforce members, including Duckett, have said the focus of additional funding should be on a broader system overhaul because there was no guarantee that raising Medicare rebates would lead to more bulk-billing or increase the availability of GP services.