Spotlight on bulk billing incentive impact

‘We’ve got lots of different measurements of bulk billing rates, and we’re hoping that they all increase.’
 
That was Penny Shakespeare, Deputy Secretary at the Department of Health and Aged Care (DoH), responding to a series of questions at a Senate Estimates hearing last Friday about the potential impact increased incentives will have on bulk billing rates, once introduced in November.
 
Much of the questioning came from South Australian Senator and opposition health spokesperson Anne Ruston, who queried whether the intent of the measure, announced in the May Federal Budget, is to increase bulk billing rates or simply stop the recent decline.
 
‘Do you have modelling that shows how many additional bulk billed consultations this is likely to generate?’ Senator Ruston asked.
 
Ms Shakespeare said while falling rates were a key factor for the measure, but there is no exact estimate on how it will affect uptake once introduced.
 
‘There have been some significant reductions recently in use of the bulk billing incentives so that that data was used in considering the decision to increase those bulk billing incentive rates,’ she said.
 
‘But there are no projections. Medicare is a demand-driven program, and we make changes to Medicare so that it can be used by people when they need health services in the future.’
 
The flagship measure allocated $3.5 billion to increase bulk billing incentives over five years and was part of one of the largest financial investments in Medicare for many years in a Budget that RACGP President Dr Nicole Higgins has called a ‘game-changer’.
 
At the time, Dr Higgins said the measure would provide GPs with more options when treating vulnerable patients.
 
‘Tripling the bulk billing incentive will help to increase access to care for those Australians who need it most and arrest the decline in bulk billing,’ she said.
 
Bulk billing rates have fallen sharply over the past 18 months, with many general practices struggling to adapt to the ongoing impact of previous rebate freezes, as well as increased operational costs.
 
Since 2021, the college has encouraged more GPs to consider switching to a mix of private billing and bulk billing.
 
Data published last month indicated that overall GP non-referred attendances had a bulk-billing rate of 78.1% for the most recent quarter, down from 88% in the same period last year – and the lowest quarterly rate in the 15 years of existing statistics.
 
A standard level B consultation was 74.7% bulk billed from January to March, compared to 84% for the same time in 2022.
 
Senator Ruston also asked what research had been done to anticipate the impact of the increased incentive in rural and regional Australia.
 
Daniel McCabe, the DoH’s First Assistant Secretary for Medicare Benefits and Digital Health, said the change will mean a bulk billing incentive of $32.70 for regional cities in Modified Monash Model (MMM 2) areas. This will go up to $41.30 for the most remote MMM 7 areas, he told the Senate committee.
 
‘The average, across Australia, out-of-pocket expense at the moment is $42 so we think that a lot of general practices, especially out in rural Australia, will be able to make decisions around bulk billing patients with these incentives for concession cardholders and people under 16,’ he said.
 
Ms Shakespeare said she anticipates the incentives are likely to reverse the current trajectory.
 
‘We do need to take action to stop bulk billing rates from trending down, which is what they’re doing at the moment,’ she said.
 
‘And we believe, based on feedback we’ve had from the sector, that this will not only arrest that downward trend, but increase bulk billing.’
 
Meanwhile, outgoing DoH Secretary Professor Brendan Murphy highlighted that the measure is intended to shore up general practice.
 
‘It’s important to note that in addition to the impact on bulk billing, this is a fundamental measure to improve the viability of general practice,’ he said.
 
‘GP peaks have said this will be a major benefit to them, because they have been concerned about their financial viability, and this will reward those who are bulk billing and stop any further decline and give a significant improvement to the bottom line of those general practices.’
 
In a newsGP poll that ran last month, 18% of readers said they will bulk bill more patients as a result of the Budget, with 70% of respondents saying they will not increase their bulk billing rate. The remainder said they were unsure.
 
Another health official at the Senate Estimates hearing said the tripling of the bulk billing incentive is likely to benefit 11.6 million Australians.
 
Ms Shakespeare said its impact will be closely watched when it does come into force.
 
‘We do monitor bulk billing rates, and we’ll continue to do that at many levels,’ she said.
 
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