Declining rural bulk-billing rates a sign of worse to come: RACGP

Doug Hendrie

5/07/2019 1:58:06 PM

Falling numbers outside the major cities ‘show that Medicare is under pressure’.

RACGP President Dr Harry Nespolon.
RACGP President Dr Harry Nespolon believes dropping bulk-billing rates in the bush are a warning sign.

Rural Australia’s falling bulk-billing rates have prompted calls for an urgent increase to patient rebates.
The rates have dropped by -0.1% to -0.5% across all rural and regional areas, while the average out-of-pocket cost has risen by over a dollar to $38.05.
‘Given almost one third of the Australian population lives outside of major cities, a 0.1% drop means there are nearly 155,000 fewer general practice consultations that are being bulk billed,’ RACGP President Dr Harry Nespolon told newsGP.
Dr Nespolon said the trend could soon be seen across the nation.
‘We fear it could only be a matter of months before we see this trend in bulk billing dropping across the entire country,’ he said.
‘Unfortunately, I am not surprised that fewer people are bulk billed outside of the major cities. This is particularly concerning given that Australians in rural areas are already experiencing worse health outcomes than those in major cities.’ 
The new Medicare data comes soon after the 1 July indexation, which will add just 60 cents to the patient rebate for an average GP consultation.
Bulk billing in Queensland and the Northern Territory fell for the first time, by 0.1% and 0.3%, respectively, while Western Australia was up by 1.2%.
Growth in Medicare billing rates increased by 0.2% nationally, though growth is slowing, as the RACGP predicted in analysis last year.
Out-of-pocket costs are up by $1.09 nationally, to an average of $38.05, though the increase was less than last year’s $1.56.  
The new data comes after Dr Nespolon publicly questioned the official bulk-billing rate of 86% and suggested that around one third of all patient consultations involve payment.
The questions around the bulk-billing rate are due to the fact patients who receive many services each year – such as older patients with chronic diseases – are likely to both receive more services, due to being sicker, and be bulk billed, due to holding concession cards.
This inflates the percentage of services bulk billed each year, but does not change the number of patients who are bulk billed each year.

Bulk billing MBS Medicare Patient rebate

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Mark van Wyk   9/07/2019 12:58:56 PM

This is not only restricted to rural, it's happening all over. During the recent elections politicians advocated that Medicare is alive and well as more patients than ever have access to Medicare. This was a deliberate strategy to bridge the discussion away from reality, being that GP practices are no longer viable after a 7 year Medicare freeze coupled with 7 years of increases across all operating costs and wages. A significant number of practices are teetering on the brink of extinction coupled with acute shortages of qualified GP's. Whilst clinicians still earn their % of billings (albeit unchanged in 7 years), the owners of these practices are left with the financial reality of the situation.

Peter Hamilton-Gibbs   9/07/2019 8:32:09 PM

Maybe there is a small trend away from bulk billing in Rural General Practice but the gap is trivial compared to the real problem of huge gap “specialist fees” often for GP like consultations. Certainly does not excuse the clumsy, poorly acted and embarrassing political TV ad produced by the RACGP immediately before the election relating to affordability of seeing a GP! Please don’t humiliate us again.