High bulk-billing rate does not reflect true costs or value of general practice

According to Federal Health Minister Greg Hunt, a record number of Australian patients are seeing their doctor without charge, as the GP bulk-billing rate has increased to 85.8% in the first half of the 2017–18 financial year. This is the highest GP bulk-billing rate ever recorded for the July–December period and represents more than 65.9 million general practice visits, an increase of 3.1 million services from the same period the year before.
 
‘Medicare has never been stronger,’ Minister Hunt said.
 
But according to RACGP President Dr Bastian Seidel, while the raw figures for bulk billing may seem impressive, they do not reflect the true costs of general practice care – or its value.
 
‘These figures refer simply to services delivered, not numbers of patients,’ he told newsGP. ‘For example, when you look at the percentage of patients who had all their GP visits bulk billed during 2016–17, it was actually around 66%.’
 
The current bulk-billing rate also fails to reflect exactly who is using the services, and how often. Data from the National Health Priority Areas has shown that a small cohort of patients account for a disproportionately high number of Medicare-funded services.
 
‘About 12.5% of Australians are frequent GP attenders, accounting for 41% of the Medicare spend on out-of-hospital services,’ Dr Seidel said. ‘These patients tend to be older, from lower socioeconomic backgrounds and experiencing at least one chronic condition.’
 
While the Federal Government’s Medicare spend has risen, so have patients’ out-of-pocket cost for GP visits, reaching an average of $34.95 over the July–December period in 2017–18. This represents a 4.5% rise in out-of-pocket costs compared to a 0.5% rise in bulk billing over the same period.
 
In response to concerns about out-of-pocket costs, Minister Hunt also announced a new expert committee to be chaired by Australia’s Chief Medical Officer Professor Brendan Murphy. The committee will investigate rising costs and treatment options, with the aim of ensuring patients have access to more information about medical fees. However, while the taskforce contains representatives from medical specialist communities, consumers, private health insurance and private hospitals, it has no GP representation.
 
Dr Seidel is supportive of increased transparency for patients around medical fees, but also wants to emphasise the enormous value represented by general practice care and ensure it is properly funded.
 
‘Proper investment in primary care has been proven, time and again, to be the most cost-efficient way to deliver effective healthcare to the Australian population, particularly as the numbers of patients with chronic conditions continue to increase,’ he said. ‘MBS [Medicare Benefits Schedule] rebates need to recognise the real value of general practice, and the RACGP recommends an 18.5% increase of the Medicare rebate for GP consultations to bring them into line with other specialists’ fees.’ 
 
Dr Seidel would also like to see that funding for general practice is properly measured.
 
‘To measure the true effectiveness of healthcare funding and do justice to the genuine costs of general practice, we need to drill down further than raw bulk-billing rates,’ he said.

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