Further sign of accelerated bulk billing decline

The decline in bulk billing and the likely continuation of that trend was the focus of multiple media reports over the weekend.
 
Much of the nationwide coverage is based on a report released by Cleanbill, an online healthcare directory.
 
It said its researchers had surveyed 4188 general practices, which it estimates account for approximately 70% of the total GP workforce.
 
According to the report, the survey included clinics across the Sydney, Melbourne, Brisbane, Perth  and Adelaide metropolitan areas, as well as Tasmania, the Australian Capital Territory and the Northern Territory.
 
Of the clinics surveyed, fewer than half (42.7%) bulk bill all patients, the report states. It puts the average out-of-pocket cost for a standard consultation at $40.25.
 
Its results also highlight huge variations in the overall rate of bulk billing between different states, with more than two in three Greater Sydney clinics (67.3%) reportedly bulk billing all their patients, but only 6.9% said to be doing the same in Tasmania.
 
Among the clinics, 369 (8.8%) are not opening their books to any new patients, Cleanbill states. 
 
The RACGP President Dr Nicole Higgins said the downward trend in bulk billing is unlikely to ease in the short term.
 
‘The rates of bulk billing will continue to decrease and we’re now hitting a critical threshold where I expect that they will decrease exponentially,’ Dr Higgins told News Corp.
 
‘It’s like asking your plumber or hairdresser to take a 50% discount on what they do.
 
‘More practices are closing, more practices are in financial difficulty and also with the threat of payroll tax on the horizon … you can’t keep the doors open if you bulk bill.’
 
The RACGP also warned last month that falling bulk billing rates are a ‘sign of things to come’, following the release of figures that suggested they had gone down from 87% to 83.4% during the first quarter of the 2022–23 financial year.
 
Importantly, those rates only reflect that proportion of services that are bulk billed rather the percentage of patients that have all their costs covered.
 
At the time, Dr Higgins said the figures did not tell the true story.
 
‘We know in the previous term of government there were claims that bulk billing was sitting at a healthy 88%,’ she said.
 
‘But a more critical look at the data revealed that the percentage of patients who had all their GP care bulk billed was sitting at just two-thirds nationally in 2020 and 2021.
 
‘For some jurisdictions, the figure was much lower.’
 
Analysis carried out last year by the Primary Care Business Council (PCBC), which represents the largest general practice operators in Australia, suggested that Medicare bulk billing rates may have fallen further.
 
It suggested there had been a 12% decline in bulk billing rates in the past two years when taking MBS item 23 as a benchmark across its clinics.
 
In the most recent Health of the Nation report, 70% of general practice owner respondents said they are concerned about the viability of their practice – up from 54% in the previous year – a pattern that is likely to be significantly affecting bulk billing rates.
 
As well as reporting a decrease in the proportion of services that are bulk billed, the report also cited factors that may have inflated official rates artificially, including a mandate on bulk billing COVID-19 vaccinations.
 
It also states that fewer than one in four GPs (24%) surveyed report bulk billing all of their patients.
 
The highest rates were in Aboriginal medical services (93%), followed by aged care facilities (44%), with solo practice standing at 39% and non-corporate group practice at the lowest end of the scale at 18%.
 
Former RACGP President Adjunct Professor Karen Price noted in the introduction to the 2022 report that an increasing number of patients are unable to find a bulk billing GP.
 
‘General practice is at a tipping point,’ she wrote.
 
‘Unless government immediately boosts investment in general practice care, more and more practices will be forced to pass the cost on to patients.’
 
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