‘The result of years of neglect’: Bulk billing freefall continues

Jolyon Attwooll

17/04/2023 4:43:29 PM

Just over a third of bulk billing clinics are taking on new patients, according to newly published survey results.

Bulk billing freefall continues
Fewer and fewer bulk billing clinics are open to new patients.

The ever-diminishing range of bulk billing options available to patients has once again had a prominent public airing following the release of a new report.
Data released on Monday by Cleanbill, an online healthcare directory, suggests that only 35.1% of clinics that are taking on new patients offer bulk billing to adults for a standard item 23 consultation.
Cleanbill had previously published data covering Australia’s main cities but has broadened the range of its research to incorporate a total of 6363 clinics around the country.
In its earlier analysis, it found that 42.7% of the clinics it surveyed always offered bulk billing to all patients. The latest study suggests an even tighter squeeze, with a number of those clinics not taking on any more patients.
The extended research includes general practices in regional and rural areas and breaks down the proportion of bulk billing clinics available by state and electorate.
The ACT and Tasmania are cited as the areas with the fewest bulk bulling options available to new patients, at 5.5% and 6.9% respectively.
NSW is the highest at 49%, followed by Victoria at 34.6%, with the NSW rate boosted considerably by western Sydney, which contains many of the nation’s highest bulk billing electorates.
The ACT also had the highest average out-of-pocket cost at $49.11 for a standard consultation, which Cleanbill founder James Gillespie says applies to an adult attending a non-bulk billing clinic during normal business hours with a Medicare card. 
The research found the national average out-of-pocket cost for a standard consultation at clinics that do not bulk bill adults sits at $40.42.
The survey suggests there are four electorates – Fairfax in Queensland, Franklin in Tasmania, Mayo in South Australia and Newcastle in NSW – that have no clinics that offer bulk billing to adults at all.
RACGP President Dr Nicole Higgins said the research reflects a situation in general practice caused by ‘years of neglect’.
‘Medicare has not kept up with the cost of running a practice, and we are now well past the point where the general practice profession just can subsidise care,’ she said.
The most recent available official statistics show bulk-billing has fallen to its lowest point in more than 10 years.
Data from October to December last year showed 80.5% of Medicare services in non-referred GP attendances were bulk billed, down from 83.4% in the previous quarter.
‘GPs have sacrificed for years to maintain access to healthcare for their most vulnerable patients, but as we’ve seen with recent practice closures, once a practice is no longer financially viable, it has no choice but to close,’ Dr Higgins said.
‘It’s simple: GPs can’t afford to subsidise Medicare anymore.’
Medicare patient rebates were frozen for six years from 2013. At the beginning of the current financial year, MBS rebates went up by 1.6%, while the Consumer Price Index rose to 7.8%.
In last year’s RACGP Health of the Nation report, 70% of general practice owners surveyed say they are worried about their practice’s viability – a significant increase from the previous year.
Around 60 clinics have reportedly closed in the past four years.
Mr Gillespie called the Cleanbill research results ‘deeply concerning’ and points out that potential information gaps remain.
‘There’s not a comprehensive list of GP clinics out there, no one has this data,’ he told newsGP.
The Federal Government this year changed the way it presents the bulk billing statistics, breaking down figures into Primary Health Networks across the country.
Official Department of Health and Aged Care (DoH) figures also show significant regional variations, with bureaucrats acknowledging bulk billing figures over recent years have been inflated by COVID-19 vaccination items.   

As with Cleanbill’s survey, the Government statistics show ACT as having the lowest rate of fully bulk billed patients, with 37.6% of people having all their services covered, excluding COVID-19 items.
Mr Gillespie highlights that the Government statistics are for all Medicare services and not just the standard consultations tracked in the Cleanbill research.
His research has had widespread attention around Australia, with localised coverage in most states and territories. Mr Gillespie says he has sent the recent report to state and federal MPs ahead of the next National Cabinet meeting, which is scheduled to take place before the end of April.
Among the measures the RACGP is calling for is a tripling of the bulk billing incentive to allow clinics to bulk bill more people, a significant increase in Medicare rebates, and greater incentives to hold longer consultations to address the growing burden of chronic disease.
An increasing number of patients are citing the fall in bulk billing as one of the biggest concerns facing healthcare in the country.
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Dr Tawhid Mohamed Sayed Hassanien   18/04/2023 12:06:11 PM

This is exactly what the government want to do ! reducing bulk billing . The cost of one submarine would be more than enough to save medicare system !

Dr A Singh   18/04/2023 3:23:39 PM

After 8 years of complete bulk billing my clinic has started billing privately for treatment room procedures. Next step would be privately billing for after hours services and finally for all consults. This step wise approach should work for all bulk billing centres in my humble opinion.

Dr Dariush Fatehee-Brujenee   19/04/2023 12:02:20 AM

medicare to increase the rebate for general practice consultations for GP's survival.

Dr Abdul Ahad Khan   20/04/2023 10:25:50 AM

The RACGP & ACRRM will continue to remain POWERLESS.
Only a Nationwide One Day ' Stethoscope Down Strike ' by all GPs organised by both Colleges & the AMA & with wide Newspaper & Media Coverage , is the only thing which will bring the Govt. to its Senses - Nurses Strike - Why should not GPs ?
Dr. Ahad Khan

Dr Paul Vernon Jenkinson   28/04/2023 1:11:33 PM

It has only ever been doctors who would fall over themselves trying to work under more difficult circumstances than required to make less money than they could be if they weren’t bulk-billing.!
The first or last subject in the medical course should be the law of supply and demand.
Think of all those years of damage to the profession and their patients which could have been avoided.