Bulk-billing changes ‘deepen fundamental problems’ with GP funding: Report

The Grattan Institute has described Australian general practice as having ‘the crudest funding model’ of any comparable system, with its researchers calling for change to improve support for more vulnerable patients.  
 
In a policy brief released this week, A better Medicare: How to reform GP funding, the public policy think tank said recent changes have poured billions of extra dollars into general practice, noting that ‘in many ways, that’s good news’.
 
However, it said the spending has ‘deepened fundamental problems with how we fund GPs’, including a stronger incentive for quick consultations with their patients, as well as leaving behind areas that ‘need more funding the most’.
 
‘Before November 2025, restricting the bulk-billing incentive to children and concession card holders was the closest thing mainstream GP funding had to a needs-based adjustment,’ its authors wrote.
 
‘It wasn’t much, but it did direct more money to clinics with more disadvantaged patients.
 
‘Expanding the incentive to all patients removed that.’
 
They said the result now is ‘the crudest funding model that our research could uncover in any comparable system’.
 
Its research also suggests the share of incentive spending heading to wealthier areas rose ‘at the expense of the poorest’.
 
‘Without the right policies, healthcare always flows uphill to the wealthiest, and Australia removed one of the few ways policy shifted GP funding towards need,’ the authors wrote.
 
For Associate Professor Rashmi Sharma, Chair of RACGP Expert Committee – Funding and Health System Reform, the broad nature of the reforms means the effect described by the Grattan Institute is ‘no surprise’.
 
‘Vulnerable populations are more complex and need extra time for their consultations,’ she told newsGP.
 
‘While tripling the bulk-billing incentive is welcome in terms of an investment in general practice, it’s not really addressing those people with complex needs, the way they have been designed.’
 
The solution, according to the Grattan Institute, is to introduce access to different types of general practice funding.
 
‘Clinics should be able to opt in to blended funding: a combination of fees for each visit and a flexible budget for each enrolled patient,’ the authors suggest.
 
‘Those budgets should be adjusted for age, sex, health conditions, disadvantage, Aboriginal status, and rurality.
 
‘No clinic would be forced into the new model, but it should be financially attractive and come with the support practices need to make it work.’
 
Associate Professor Sharma, however, is wary about guiding Australia towards a similar model to the NHS – and points towards the college’s advocacy for more investment in longer consultations, mental health care, and chronic disease management.
 
She describes these areas as ‘underfunded and vital to high-quality general practice’.
 
‘The college has called for a change in funding, but not to throw the baby out with the bath water because we know that fee-for-service has brought us a world-class health system in Australia,’ she said.
 
‘We know that it does drive efficiency and it’s a model that works well – but we do know that it’s a bit of a blunt instrument for people that don’t fit nicely into that model.
 
‘It’s the increasing load of patients with complex and chronic disease where there needs to be alternative forms of funding that complement fee-for-service.’
 
Log in below to join the conversation.

bulk billing general practice funding Grattan Institute Medicare