Stark differences in Medicare co-payments revealed

A new survey has revealed high variation in Medicare co-payments across suburbs in Australia’s major cities, but GPs say comparing out-of-pocket costs doesn’t tell the whole story.
 
Online health directory Cleanbill released a series of Pricing Analysis Reports on Thursday, exploring patient access to fully bulk-billed GP clinics, as well as out-of-pocket costs across Sydney, Perth, Melbourne, Brisbane, the Sunshine Coast, and Adelaide.
 
Suburb comparisons were made as a further drill-down of Cleanbill’s recent Blue Report, which showed the nationwide rate of universal bulk billing for non-concession card holders is just over 20%, while the average out-of-pocket cost to patients is $43.
 
Cleanbill founder James Gillespie told newsGP that ‘in every large population centre, the suburbs with the highest average out-of-pocket costs for a non-concession standard consultation are within a 35-minute drive of those with some of the lowest average costs’.
 
‘As the percentage of clinics that will bulk bill a non-concession adult has continued to fall over the past couple of years, these out-of-pocket costs become increasingly important for Australians seeking affordable, available care around them.’
 
Sydney was found to have the highest variation in average out-of-pocket costs, with the highest gap in Woollahra at $103.82, while patients paid $80 less in Parramatta, a 35-minute drive away.
 
In the Victorian suburb of Toorak, the average out-of-pocket cost of a standard consultation is $62.15 while the same service averaged $35 less in Keysborough, some 30 minutes away.
 
Over in the west, Perth patients paid an average out-of-pocket cost for a standard consultation of $61.90 in the suburb of Como, while the service cost $30 less in Beckenham, a 20-minute drive away.
 
RACGP President Dr Michael Wright said that with an almost 10-year Medicare rebate freeze, now lifted, rebates did not keep pace with the cost of providing care, meaning out-of-pocket costs have become more common.
 
‘The latest Medicare statistics show that more than 75% of GP services were bulk billed in the last quarter. Bulk-billing rates have fallen from their peak, but these show the majority of GP services are still delivered without additional consultation costs for patients,’ he said.
 
‘To clarify, this report can be a little confusing as the bulk-billing rates mentioned refer to practices that bulk bill everyone at the practice – or universal bulk billing. These figures are much different to the Medicare statistics.
 
‘We know that practices most commonly operate under a mixed billing model, with some patients being privately billed and others bulk billed.
 
‘Last week’s release of the Grattan Institute report data into non-GP specialist fees shows that GP fees have been much more stable and restrained than those for other medical specialists.’
 
GP Dr Tim Senior, Chair of RACGP Specific Interests Poverty and Health, said the patient co-payment reflects the cost of that individual practice providing care to its patients.
 
And when GPs put through their Medicare items, ‘while it looks like that comes straight to the GP, it’s actually responsible for keeping the lights on, employing receptionists, practice managers, practice nurses’.
 
‘You can look at the figures from two ends. One is by looking at the cost to the patient of seeing a doctor, and clearly the Government wants that cost to be as little as possible, because affordability is a big issue,’ Dr Senior told newsGP.
 
‘But from a practice and health system point of view, it’s about the required funding to provide a health service, and to fund a health system … what patients are paying is what’s required to fund the practice, so if bulk billing doesn’t fund the practice to provide the service, then patients will pay a co-payment.
 
‘There is going to be a clear socio-economic gradient about the access to the co-payments, because GPs are really responsive to the needs of their patients in their community, and in areas where patients can’t afford co-payments, then that’s where GPs do provide most bulk billing.’
 
While Federal Health and Ageing Minister Mark Butler is not convinced this new survey adds value to the conversation, he concedes that many low-income patients are still paying a gap fee.
 
‘What we do as the Government on a quarterly basis is we publish comprehensive bulk-billing data that will tell you exactly the percentage of GP visits across the country, by state, by federal electorate, bulk billed,’ he said.
 
‘What we know is that that number was plummeting when we came to Government, it started to turn around when we tripled the bulk-billing incentive for pensioners and kids.
 
‘We’re still very concerned that bulk billing for Australians without a concession card, so about 60% of the population, is still dropping.’
 
Minister Butler said that is the reason behind the Federal Government’s controversial $8.5 billion plan to overhaul Medicare, which, it says, will lead to 90% of GP visits being bulk billed.
 
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