‘A complete reversal’: Surge in bulk-billing practices

The number of general practices offering full bulk billing has skyrocketed – but out-of-pocket fees are also rising sharply, according to new research.  
 
Figures published by online health directory Cleanbill in its annual ‘Blue Report’ on Monday indicate that 1007 clinics switched from mixed billing to full bulk billing in the past 12 months.
 
In a survey of 6877 general practices around the country, conducted since the new tripled bulk-billing incentives came into effect on 1 November, it found 40.2% now offer full bulk billing.
 
That compares to 20.7% when the same survey was conducted last year, with Cleanbill founder James Gillespie describing the change as ‘a complete reversal’ of trends over the past three years.
 
The research found Tasmania has 37 clinics where bulk billing is now available to new patients, compared to none 12 months previously.
 
Last week, a Department of Health, Disability and Ageing spokesperson told newsGP more than 3200 practices had registered nationally for the Bulk Billing Practice Incentive Program.
 
This is an increase from 2902 reported by officials in December, with 58% of those being clinics that previously fully bulk billed.
 
For RACGP President Dr Michael Wright, the trend outlined in the Cleanbill survey is not a surprise, particularly given earlier indications from health officials.
 
‘We recognised from the beginning this additional funding would be a welcome support for many practices, particularly in rural and remote areas that have long required targeted help,’ he told newsGP.
 
‘This latest Cleanbill report shows more bulk-billed appointments are available for new patients, which is a reflection of those changes.
 
‘We have also said consistently there are many GPs and practice owners around the country for whom the incentives may not work – and they will continue to act in the best long-term interests of their patients, their practices and the communities as they have always done.
 
‘The RACGP strongly supports their right to choose their own business model and will continue to support all GPs and clinics regardless of the billing set-up they choose.’ 
 
The Cleanbill survey also indicates that out-of-pocket costs for patients who are not bulk billed have risen substantially in the same timeframe, with the average gap fee across the country reportedly leaping by 13.5% in 12 months to $49.23 for a standard consult.
 
According to its report, New South Wales had a greater proportion of clinics (51.9%) offering new patients bulk-billed appointments than any other state, but its average out-of-pocket costs also spiked to $50.51, second only to Tasmania ($60.76) among the state jurisdictions.
 
Both territories also had high fees for non-bulk-billed patients at $57.96 and $55.04 for the ACT and the NT respectively.
 
Again, Dr Wright said the shift is not unexpected, with the RACGP’s Health of the Nation report showing the complexity of consults is increasing, as well as the average length of consultations.
 
‘After a near decade long Medicare freeze and years of chronic underfunding, many GPs are nervous about switching back to a system that once again makes them 100% reliant on Government funding decisions,’ he said
 
‘For these GPs, this decision is fundamentally a trust issue, not just a financial one. 
 
‘While this Government has shown its commitment to Medicare, there is no guarantee a future government will do the same. GPs need long-term certainty for their practices and for their patients. 
 
‘Nobody wins if practices are forced to close their doors for good because practice running costs can’t be covered. 
 
‘We ask all patients, and the Government, to respect the billing practice of their GP, and to speak to practice team staff members with respect and courtesy – they’re only doing their job.’
 
In previous years, Cleanbill showed a significant decline in the number of clinics offering bulk billing to every patient.
 
Its report this week also indicates a net decline in the number of general practices around the country, with 48 fewer clinics recorded compared to the previous year – although still higher than the 6818 recorded in a 2024 report.
 
Federal Health and Ageing Minister Mark Butler told the ABC the data in the Cleanbill report ‘should not be relied upon’.
 
Meanwhile the Shadow Health and Ageing Minister Anne Ruston acknowledged ‘a welcome increase in the number of bulk-billing clinics’ but said the Cleanbill report ‘confirms access is becoming more unequal’.
 
The Federal Government has a target of increasing the overall rate of bulk billing to 90% by 2030.

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