‘GPs can no longer subsidise care’: Bulk billing hits lowest mark in a decade

Jolyon Attwooll

21/02/2023 3:34:55 PM

Fresh figures show general practice bulk-billing rates continue to slide as the Department of Health releases new details for the first time.

Doctor doing sums
The last time bulk-billing rates dropped below 80.5% was 2011.

The overall bulk-billing rate in general practice has hit its lowest point since 2011, according to newly released MBS figures.
The latest data shows that 80.5% of all Medicare services provided in non-referred GP attendances were bulk billed during the recent December quarter.
The last time the quarterly figure dipped below that number was in 2010–11 when the figure hit 80.2% in that financial year’s March quarter.
RACGP President Dr Nicole Higgins told newsGP the downward trajectory reflects the growing pressures on general practice.
‘GPs can no longer afford to subsidise patient care,’ she said.  
‘GPs have simply had enough – many have had to make the difficult decision to move to mixed billing and pass on some of our costs on to patients just to stay afloat.
‘As a patient, I would be asking the Government, “Why haven’t they invested in my Medicare rebate?”
‘I am encouraging my patients to go to their local MP and tell them that this is not good enough. This is the result of successive governments neglecting general practice.
‘[Federal Health and Aged Care] Minister [Mark] Butler has an opportunity to turn this around by investing in general practice.’
Dr Higgins said the pressures on general practice have only intensified further over the past year with the rising cost of living.
The Consumer Price Index hit 7.8% last year, while MBS rebates went up by just 1.6%. 
‘Medicare is still effectively going backwards,’ the RACGP President said.
‘Unless we get more support to do vital work in our communities, providing life-long, continuous, patient-centred care, these bulk-billing figures are only going to accelerate in the same direction – and put more medical graduates off from getting involved in what can be one of the best careers in medicine.
‘Tripling the bulk-billing incentive is one measure the college is strongly advocating, which would certainly help stem the bleeding.’
More transparent data
The latest quarterly statistics were released the same week as new data showing the proportion of patients who were bulk billed for every service they received.
The Department of Health and Aged Care (DoH) figures, made public for the first time, show considerable variations between different Primary Health Network (PHN) areas across the country.
Statistics were published both including and excluding COVID-19 vaccination items, which have to be bulk billed and which the Government acknowledged had been artificially inflating the figures.
The ACT had the lowest rate of patients who were fully bulk billed according to these new statistics, with 37.6% of people in the region having all their services covered by bulk billing, excluding COVID-19 vaccination items.
Rates in Tasmania were also low at 44.8%, while the highest rates were recorded in South Western Sydney at 91.5%, a rate closely followed by Western Sydney (90.3%).
Minister Butler told Nine Newspapers that the previous government had masked ‘a shocking decline’ in bulk bulling.
‘My department will now regularly publish the data on how many Australians have all their visits to the GP bulk billed,’ he said.
‘Being transparent with the public is the first step.
‘I will continue to engage with all healthcare stakeholders, including consumer groups, unions and doctor groups to ensure we increase affordability and deliver our reforms to strengthen Medicare.’
Tasmanian GP Dr Emil Djakic, a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), welcomed the greater transparency offered by the figures.
‘This data is the first time we’ve seen what we’ll call a much more truthful dataset,’ he told newsGP.
‘It’s nice to see these statistics give a little more detail to allow us to think more broadly rather than the dumbed-down use of statistics with a single number representing bulk billing.
‘The college has been arguing for some time that we need better data to accurately reflect what is going on so that we can have a discussion with the Government in a more realistic way.’
According to Dr Djakic, one factor affecting the overall figure of patients being completely bulk billed in Tasmania is the spread of the state’s population.
‘We’ve got a lot more people living in regional rural areas, rather than major cities, and that puts different pressures on the GPs working in those communities,’ he said.  ‘I’m included in that.’
However, he expressed concerns about the sustainability of practices where the bulk-billing rate remains high, such as the areas in outer Sydney.
‘That scenario is a big race to the bottom in terms of price point, which eventually leads to an inability to sustain the business,’ he said.
Further statistics that were also released this week show that the average patient contribution has risen from $40.28 to $41 in the past 12 months.
Dr Djakic said a long-term policy of fiscal restraint on Medicare has made it harder for people to gain access to quality primary care.
‘We’re also having difficulty retaining and attracting our best and brightest to deliver the most important part of the medical profession,’ he said.
‘Clearly, the focus should be on citizens who are finding it harder to pay for the costs associated with the delivery of primary healthcare.
‘The insurer has reneged on their responsibility.’
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Dr BM   22/02/2023 11:18:45 AM

The rates are massively inflated because they are by episode (consultation ) not by patient. So people who very frequently visit the GP, and are often bulk-billed, are skewing the data. If the rate is done by patients (not episode/consultation) per year then the rate will be far lower.

Dr Suresh Gareth Khirwadkar   22/02/2023 12:59:49 PM

I don’t know why Racgp is so addicted to bulk billing. It may be an unpopular take, but tripling bulk billing incentives will just further incentivise 6 minute medicine. It will not improve the quality of care.

Dr Richard Mark Smith   22/02/2023 9:10:09 PM

Bulk-billing is a 66% discount on the retail fee causing business model to fail

Dr Maria Rasool   23/02/2023 7:12:59 AM

In the mixed billing model the privately billed patients are those who are young and working and already paying all the taxes. It's not fair to charge those who already are paying taxes.

Dr Peter James Strickland   23/02/2023 11:57:26 AM

The message from the RACGP (and AMA) to the Federal Minister for Health is that no longer will bulk-billing be done by RACGP/AMA members, NOR advocated by the RACGP --the latter is essential! There is NO indication the present government is going to increase rebate rates to inflation (over about 20 -30 years now), so an ultimatum should now be made. The basic Item 23 rate now should be about $60 plus --that should be the indicator for the increase level of ALL rebates. Result-- less cost to government, as there will be a massive decrease in hospital costs for GP-type consultations in EDs that are always more expensive on the public purse. Bite the bullet RACGP and AMA and stop molly-coddling!

Dr Pran Lal   16/03/2023 11:41:48 AM

The govt should look at what is happening with the world. Bank after bank Collapsed before the Fed stepped in, to guarantee deposits. Despite that, the contagion has spread to Europe with Credit Suisse collapsing today. This will spread world wide.
SAME is happening to bulk billing. Unless Medicare steps in quickly and sets reasonable rates , once clinics leave Bulk Billing, they are unlikely to return to BB.
THE longer Medicare takes to fix this issue, the worse off will be the public. Winter is coming. EDs will overflow.