Out-of-pocket costs rise as bulk billing plummets: Survey

Rising out-of-pocket costs are continuing to place more pressure on affordable patient care, according to a new survey.
 
The results of a report released on Monday 8 January by healthcare directory Cleanbill also found that 514 clinics in Australia that bulkbilled all their patients in early 2023 have now stopped doing so.
 
The research, which compared the results of a similar survey released in April last year, suggests that fewer than one in four clinics (23.6%) now bulkbill all their patients, a decline of more than 11 percentage points in less than a year.

A total of 6818 clinics were surveyed for Cleanbill according to its founder James Gillespie, with average out-of-pocket costs standing at $41.68 – a rise of more than 3% from the previous survey.
 
The highest out-of-pocket costs – as well as the lowest universal bulk billing rate – were recorded in Tasmania, where patients can expect to pay an average of $51.67 in addition to the patient rebate for an item 23 consultation.
 
NSW and Victoria are the only jurisdictions where more than 20% of clinics were found to be bulk billing all their patients at 37.2% and 24.4% respectively.
 
According to official figures, the overall proportion of non-referred bulk billed GP services hit an historic new low in the July to September 2023 statistics at 76.5%.
 
RACGP President Dr Nicole Higgins said the new data provides more evidence of the need for decisive action to improve access to care.
 
‘This report shows we need to do more to address the rising costs for care in Australia – patient financial issues were also one of the top concerns GPs reported in our 2023 Health of the Nation,’ she said.
 
‘While the Government’s tripling of bulk billing incentives has helped more GPs bulk bill specific groups, including children, pensioners, and healthcare card holders, more needs to be done to ensure care is affordable for the rest of the population.
 
‘This situation is a direct result of the 10-year freeze on patient Medicare rebates.
 
‘This ripped funding from general practice, so now even though more people access general practice than any other health service, it gets just 6.5% of the total government spend on healthcare.
 
‘Practices are also facing the same inflationary pressures as other businesses.’
 
Mr Gillespie said one of the reasons he waited until late 2023 to update the data was to ensure it would reflect choices made following the Government changes that came into effect on 1 November last year, including the tripling of the bulk billing incentive.
 
‘The incentive changes only impact payments to clinics for seeing certain cohorts [children, concession card holders and pensioners], but there was some conjecture in May that the increased payments for these patients would offset fees for other patients, keeping other fees low,’ he told newsGP.  
 
‘This is not something that we’ve seen borne out in the data.’
 
He also flagged research that suggests more people are delaying visits to the GP.
 
According to the most recent Australian Bureau of Statistics (ABS) data released in November last year, the proportion of patients who pushed back or avoided a GP consultation has doubled.
 
The latest ABS figures indicate 7% of people viewed out-of-pocket costs as a barrier to care. The most affected cohorts were younger people and those living in areas of greater socioeconomic disadvantage.
 
Mr Gillespie, who said he self-funds the Cleanbill research but hopes the directory will eventually become financially self-sustaining, believes his data could help patients select a general practice.
 
‘As fewer clinics bulk bill, it becomes imperative for Australians to be able to see the cost of going to a doctor wherever they are before they book in,’ he said.
 
‘If people don’t know how much it’ll cost to see a doctor near them, they’ll increasingly just avoid seeing the doctor.’
 
Dr Higgins meanwhile also called for more action to reduce the financial burden on general practices, including on payroll tax.
 
‘So far Queensland is the only state which has issued a new revenue ruling stating patients’ fees paid directly to a GP won’t be subject to payroll tax, and we’re continuing to call for other states and territories to do the same,’ the RACGP President said.
 
She believes any retrospective tax collection would also force more practices to close.
 
‘It’s absolutely vital that everyone can afford general practice care – it helps people live healthier lives and reduces pressure on our hospitals,’ she said.
 
‘It’s also our most cost-effective health service, with a 20-minute GP consult costing around $40, whereas a visit to hospital costs over $600, and much more if a patient is admitted.
 
‘The Government knows action is needed and they’ve committed to rebuilding Medicare and general practice.
 
‘While there’s no quick fix, we do need to keep up the momentum to secure the financial sustainability of general practice, enable bulk billing for those who need it, and ensure GP care is affordable for everyone.’
 
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bulk-billing Cleanbill out-of-pocket costs