How many practices have switched to the new bulk-billing program?

After more than nine months of debate, discussion and preparation, the Federal Government’s flagship bulk-billing expansion program is live, with its impact under close scrutiny.
 
However, according to the Government’s own data, released on Monday, just 622 of Australia’s 4720 metropolitan practices plan to change from mixed-billing to bulk-billing in the wake of the changes.
 
This is in addition to the 935 practices which are already fully bulk-billing clinics.
 
The data, gathered from an expressions of interest (EOI) process, shows 209 of Australia’s 620 regional practices have indicated they will become bulk-billing practices, with 108 clinics intending to change their current approach.
 
Seventy-three clinics in large rural towns plan to switch, with the strongest growth expected in small rural towns, where more than 60% of the 243 interested clinics do not currently bulk bill all patients.
 
The figures come after an intensive promotional campaign ahead of the Bulk Billing Practice Incentive Program’s launch, which included Federal Health and Ageing Minister Mark Butler making several references to anticipated increases in GP earnings.
 
He also said the Government is prepared to intervene in markets where bulk-billing rates remain lower than official modelling.

In response, RACGP President Dr Michael Wright described the figures used as a ‘misrepresentation’ that does not take into account the full complexity and costs of providing care.
 
He was also critical of the language used about both earnings and market interventions.
 
‘We’ve been in touch with the highest levels of government to push back against this unhelpful public positioning because it does nothing to restore the trust that GPs will need to participate in this program,’ he told newsGP.
 
The Government’s earnings figures are based on a calculator provided by General Practice Registrars Australia (GPRA), which includes a disclaimer that it should be used as ‘an indicative guide only’. 
 
‘It does not fully reflect the complexity of billing or working in general practice, including using only level B appointments [which attract more income per minute than longer consults],’ the GPRA website states.
 
‘It also does not consider the non-patient facing time that GPs undertake to ensure safe care, including checking results, other non-remunerated administrative tasks, and ongoing education.’
 
Port Adelaide’s Trinity Medical Centre is one clinic that is switching to full bulk billing due to the new incentive program, and it was chosen as the site of Minister Butler’s launch of the program, where he was joined by the practice’s Dr Derek Loh.
 
‘I always believe that bulk billing is a good way to practise medicine because we don’t want patients to make decisions about their healthcare based on their financial circumstances, but more what their health needs,’ Dr Loh said.
 
‘We couldn’t bulk bill previously because the gap between concession card holders and non-concession card holders was getting big, and it wasn’t financially viable for us.
 
‘But now that we’ve increased the new subsidies and incentives, we are able to bulk bill all patients.’
 
In previous modelling, the DoHDA said it anticipates 1603 clinics to sign up in 2025–26, which it expects to increase to 3206 by the end of 2026–27, and 4573 a year on from that.
 
If all the EOIs reported translate into clinics taking up the new incentives in full, it will put the Government ahead of its target for the first financial year.
 
The new Government data also shows the electorates with the most mixed billing practices intending to switch to full bulk billing, including five regional areas: Ballarat (Victoria), Hinkler and Flynn (Queensland), Cowper and Parkes (NSW).
 
Five metropolitan areas also feature in the top 10, including Rankin (Brisbane), Hawke, Calwell and Hotham (Melbourne) and Spence (Adelaide).

It remains unclear whether EOIs will translate to uptake of the program – or, conversely, if other clinics will take part without submitting an EOI.
 
Last week, a DoHDA spokesperson said that hundreds of existing bulk-billing clinics have not yet expressed interest ‘noting that EOIs are still being received and there is no requirement for practices to submit an EOI to join the program on 1 November’.
 
Spruiking his incentives plan on Monday, the Health Minister called bulk billing ‘the beating heart of Medicare’.
 
‘I want every Australian to know they only need their Medicare card, not their credit card, to receive the healthcare they need,’ Minister Butler said.
 
However, Shadow Health and Ageing Minister Anne Ruston said many Australians will still need to pay to see a GP.
 
‘Anthony Albanese is creating false expectations among Australian families at a time when the cost-of-living pressures, healthcare costs and power bills continue to rise,’ she said.
 
For Dr Wright, it is important that the Government and patients respect individual decisions made by GPs and practice owners, who he said are making ‘thoughtful, professional decisions, in the best interests of their practice and patients’.
 
‘While there are many clinics that will benefit from taking up all these incentives, we also know that thousands of practices will not,’ he said.
 
‘Practices need to be supported as they continue to serve their community and work in the best interests of their patients and their long-term viability.
 
‘As GPs, it is essential we are able to continue to provide high-quality healthcare to people all around the country, whatever the billing model.’
 
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