‘Huge financial disincentives’ lead to drop in GP home visits

There’s a ‘huge financial disincentive’ for GPs to undertake home visits, says a GP expert, after an analysis revealed an 85% drop in the visits over recent decades. 
 
A deep dive into Medicare data shows GP home visits have declined from almost four million in 1994 to under half a million in 2024.
 
Associate Professor Joel Rhee, Head of General Practice at the University of New South Wales, conducted the analysis and says a key driver is remuneration that ‘just doesn’t pass the pub test’.
 
‘One of the greatest issues is that there’s a huge financial disincentive for GPs,’ he told newsGP.
 
‘For example, for a GP doing a home visit, their Medicare rebate would be slightly over $30 greater than the rebate that they’ll receive if they saw the patient in their clinic.
 
‘Most people would think the petrol cost, the car cost and the time it takes to drive somewhere and come back is surely going to be worth more than $30.
 
‘That amount is also a singular amount. If a GP did three or four home visits in a row, it’s not that they’ll be paid $30 times four, it’s that $30 is somehow expected to cover all that travel time – it just doesn’t make sense.
 
‘And what’s interesting is that there has been an increase in the rebate for travel for GPs visiting aged care homes but the same hasn’t occurred for home visits.’
 
Associate Professor Rhee said several other factors are preventing GPs from taking on home visits, including personal safety concerns and the rise of part-time work.
 
He added that this dramatic drop in home visits over time has an ‘equity dimension’, with those who require the service being most in need, including patients with end-of-life care needs, disability, and older people.
 
The only avenue left for these patients is telehealth, which isn’t a substitute for face-to-face GP care, Associate Professor Rhee said.
 
‘While telehealth is very useful, and it’s definitely better than having nothing, the problem is that it doesn’t permit even basic things like physical examination,’ he said.
 
‘There’s a huge advantage and benefit to actually seeing a doctor face to face, especially for people who might have communication difficulties, a disability or hearing loss.
 
‘Doing something over a small screen versus actually seeing a person in real life and interacting with them, even just shaking a person’s hand, I think makes a huge difference.’

Melbourne patient Rachel Croucher, who lives with a disability and has complex care needs, has struggled to find a GP who can provide home visits.

‘GP home visits are vital for keeping people living with disability out of hospital and ensuring health resources are used effectively,’ she told newsGP.

‘If I’m experiencing a bad health spell and cannot physically reach a GP, my risk of ending up in the emergency department and developing long-term complications rises significantly.

‘Easier access to a GP at home would mean I wouldn’t have to wait until the complexities of my condition become acute to receive care.’ 
 
Associate Professor Rhee said while other health services are doing their best to help these patients, significant challenges remain.
 
‘Many things just require a doctor. And I think being able to do home visits is an important part of being a GP,’ he said.
 
Associate Professor Rhee said he and colleagues will be exploring the topic of GP home visits later this year under a research grant from the Australian General Practice Research Foundation.

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