Survey feeds concern over costs for GP care

​ Only one in five new adult patients without a concession card are being bulk billed for all their GP appointments, according to a new report published by online health directory Cleanbill.
 
Its research, released on Monday, put New South Wales as the region with the highest rate of universal bulk billing for non-concession card holders at 34.5%, with Tasmania recording the highest gap fees at an average of $54.26 per standard MBS item 23 consultation.
 
Cleanbill suggested the nationwide rate of universal bulk billing for non-concession card holders had decreased from 35.1% in 2023 to 20.7% today. It also reported an annual increase in gap fees of 4.1% nationwide to an average of $43.38.
 
The Australian Capital Territory had the second highest average out-of-pocket cost at $51.84, followed by $44.05 in New South Wales, and $43.86 in the Northern Territory – all above the national average.
 
The second highest bulk-billing rate for non-concession card holders was found in Victoria at 19.1%, followed by 13.9% in Queensland, and 9.5% in the Northern Territory.
 
According to Cleanbill’s Blue Report, the findings are based on a survey on pricing and availability of 6925 general practices carried out from October last year.
 
It also drew attention to a rise in the number of people avoiding GP visits due to cost concerns, citing analysis published by the Australian Bureau of Statistics (ABS).
 
Last November, the ABS published its annual Patient Experience Survey, which found the number of people who did not visit their GP due to cost concerns increased from 7% in 2022–23 to 8.8% in 2023–24.
 
The Cleanbill survey follows a series of reports in Nine Newspapers which analysed the increase in bulk-billed appointments for children and concession-card holders while highlighting growing cost pressures on working-age adult patients.
 
While no details have yet been announced, the newspapers also reported that expanding access to bulk-billing is likely to be a key federal election pledge for the Labor Party.
 
RACGP President Dr Michael Wright said there is clear evidence such funding would help increase access to GP care and cut out-of-pocket costs after decades of underinvestment and a Medicare freeze.
 
‘Government data and the RACGP’s Health of the Nation report have shown the tripling of incentives has helped GPs bulk bill more children and concession card holders, particularly in rural and remote areas where the incentives are highest,’ he said.
 
‘But most Australians aren’t eligible for higher incentives and they’re missing out.
 
‘The RACGP has been calling for an increase in patient rebates, particularly for longer consultations, which more and more Australians need to manage chronic and complex illnesses.  
 
‘This will make a real difference for patients and communities across the country. It will improve the health and wellbeing of our population and take pressure of our hospitals and entire health system.’
 
However, Cleanbill’s approach and conclusions have been strongly queried by the Department of Health and Aged Care (DoHAC) and Federal Health and Aged Care Minister Mark Butler.
 
Minister Butler told the ABC he was ‘cautious’ about the report, describing it as ‘essentially... a ring around of general practices to ask them whether or not they bulk bill every single person that comes through their front door, whether it’s Gina Rinehart or an aged pensioner’.
 
He also emphasised the impact of the tripled bulk-billing incentive, which came into effect for children and concession card holders in November 2023.

Minister Butler said more bulk billing has taken place in every state and territory since it came into effect, and that the number of GP visits had increased overall in the past year by 1.2 percentage points.
 
‘Official data shows our record investment to strengthen Medicare has stopped the freefall in bulk billing that was created under the Liberal and Nationals Government,’ he told newsGP.
 
Minister Butler’s office also said the Cleanbill report is unlikely to reflect the experience of all individual patients, citing data suggesting adult patients without a concession card are still frequently bulk billed at mixed billing practices.
 
While the RACGP strongly welcomed the tripled bulk billing incentive when it was first announced in May 2023 and has commended its subsequent impact, Dr Wright believes further reform is needed to benefit the wider population.
 
‘Today’s patient rebates don’t come close to the cost of care, so people are paying more out-of-pocket, and it’s harder for GPs to bulk bill. On top of this, practices have been hit by inflation like everyone,’ he said.  
 
In his response to the recent Cleanbill report, Minister Butler also indicated that further investment in Medicare is likely.
 
‘We know there’s more to do to keep strengthening Medicare after a decade of cuts and neglect from the Liberals, and we are committed to doing it,’ he said.

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